"He was very fit Sir"
60y guy. Heart attack 2y ago. Multiple blocks - advised bypass surgery. Didn't get it done. Medication stopped. Took herbal treatment. No follow up with Cardiologist. Now presented with cardiac arrest. Brain dead. What many people think as "fit" - just means… twitter.com/i/web/status/1…
So when people say somebody vert fit or apparently healthy died suddenly, I always take it with a pinch of salt because many a times, underlying health conditions existed and were ignored and not taken care of. Commonest being uncontrolled #Diabetes or #hypertension.
Not all coronary artery disease patients need angioplasty or surgery, but strict control of blood pressure, cholesterol and diabetes becomes super important. Plus regular exercise and diet control. Follow up with a Cardiologist to keep a check needed too on a regular basis.
Stopping #smoking is crucial to improve survival as we can see in this graph
Regular exercise has a direct effect on reducing death from heart disease as well as other causes.
Just because a few people died here and there during exercise doesn't mean exercise is the killer. The real killer is sedentary lifestyle. But no one reports someone dying in sleep or lying on the couch, but every death in gym gets international coverage. That's just reporting… twitter.com/i/web/status/1…
Stents save lives in heart attacks when a coronary artery is occluded acutely. In other cases it us mainly to reduce symptoms(angina) and improve quality of life.
Bypass surgery is largely about reducing angina and improving quality of life. But in severe triple vessel disease and left main disease, left ventricular dysfunction, bypass surgery reduces mortality.
Prevention of CVD

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More from @DrDeepakKrishn1

Mar 11
Two patients scheduled for procedures early on Saturday morning cancel and postpone in the last moment without any prior notice. And I'm here an hour early at the hospital. People have no sense of responsibility or value of time or an idea how things work. #MedTwitter
Anything can be the reason. Unable to make up the mind, going to a different doctor or hospital, wanting to continue medication and see how it goes, want to do it at a different date.. all one needs is to inform. Just canceling at the last moment disturbs all plans and… twitter.com/i/web/status/1…
Many a times doctors reschedule other less critical cases and give priority to cases which need urgent attention. Plus OPD scheduling also happens accordingly. Personal plans are put aside too. Everything goes for a toss when patients do not show up in the last minute!
Read 4 tweets
Dec 13, 2022
The difference between "Gas" and a heart attack is just one blocked coronary artery!

Any gas or indigestion can be a heart attack if
1. Lasting more than an hour
2. Increasing severity
3. Associated sweating
4. Not relieved by antacids
5. + chest/jaw/arm pain #heartattack
Typical versus atypical symptoms of heart attack
Read 10 tweets
Dec 2, 2022
An atherosclerotic plaque or in layman words block in artery can progress in two different ways
1. Arithmetic progression - slow over many months/years due to slow accumulation of cholesterol
2. Geometric progression - over shorter duration due to erosion or rupture #MedTwitter
In case of heart attacks progression from 40-50% to 100% occlusion happens suddenly over minutes due to blood clot and leads to severe chest pain and death if not treated immediately. These plaques are called vulnerable plaques as compared to stable plaques.
I'm simple words vulnerable plaques are more soft and inflamed. Hence liable to rupture. Even if 100% occlusion doesn't happen, a plaque can progress rapidly if it is vulnerable to clot formation and healing with a reduction in diameter of vessel.
Read 8 tweets
Nov 29, 2022
13y old girl with Dengue fever. Was admitted in severe shock and myocarditis. LVEF 25%. Going home after a week with complete recovery. LVEF 55%.
To see children as patients is very tough. Hats off to all pediatricians and specialities dealing with kids.
#MedTwitter ImageImageImageImage
Read 5 tweets
Nov 23, 2022
30y guy presented with palpitations while playing cricket. Pulse was 220/min. Was given IV medication and reverted to normal rhythm in emergency dept. He had similar palpitations in the past, few times, but lasted few minutes and became normal so he did not seek help #MedTwitter
After IV medication. ECG showed pre-excitation pattern. So basically a case of WPW syndrome.
In Wolff-Parkinson-White (WPW) syndrome, an extra signaling pathway between the heart's upper and lower chambers causes a fast heartbeat (tachycardia). WPW syndrome is a heart condition present at birth (congenital heart defect). It is fairly rare.
Read 11 tweets
Nov 23, 2022
While there is hue and cry about young people getting heart attacks/cardiac arrests and dying, we have so many young people who visit emergency/OPD with chest pain and ECG changes and need admission and treatment, but are in denial and refuse admission and go home. #MedTwitter
ncbi.nlm.nih.gov/pmc/articles/P… a good write up about denial of cardiac illness
@askdheeraj how do we deal with this?
Read 4 tweets

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