Up to 50% of women report sleep problems in midlife, and cardiovascular disease (CVD) is the leading cause of death in women
Insomnia - defined as trouble falling asleep, waking up several times a night, or waking earlier than planned more than 3 times/week.
SWAN (Study of Women's Health Across the Nation) looked at association of insomnia with cardiovascular risk. #MedTwitter At baseline, SWAN participants (n=2964) were 42 to 52 years of age, premenopausal or early perimenopausal, not using hormone therapy, and free of CVD. They completed up to 16 visits, including questionnaires assessing insomnia symptoms (trouble falling asleep, waking up several times a night, or waking earlier than planned ≥3 times/week classified as insomnia), typical daily sleep duration, vasomotor symptoms, and depressive symptoms; anthropometric measurements; blood tests; and CVD event ascertainment (ie, fatal or nonfatal myocardial infarction, stroke, heart failure, revascularization). #Sleep

42-year-old lady had acute chest pain. ECG showed significant changes. Told her it looks like a heart attack. She was very nervous and worried. Despite telling her not to go, she went back to meet her physician, who convinced her and sent her back. I did an angiogram, which showed 99% narrowing in one artery. Stented successfully. Today, she went home happy after 2 days in hospital. Came to my room and hugged me, and tried to fall at my feet 🥹. #MedTwitter
She was detected to have very high cholesterol and blood pressure, which were undetected before.
Most such heart attack patients have risk factors that haven't even been detected before. A very small percentage would really have no obvious risk factors. Even they would have genetic risks that are difficult to detect. #MedTwitter
Cardiovascular illness is the leading cause of death in women too! Especially if women smoke or develop diabetes, their risk is same as men.

Being treated for palpitations, breathlessness, and anxiety for 4 months, this 49 year old lady turned out to have Thyrotoxicosis or Graves' disease when I asked for a thyroid test. Subsequently, she was seen by an endocrinologist, and an isotope scan confirmed the diagnosis.
We need to be physicians first and then "super specialists!" #MedTwitter #CardioTwitter
Many patients with a hyper functioning thyroid can present with cardiac symptoms like palpitations, exertional breathlessness and even chest pain. In some cases it may lead to cardiac arrhythmia especially atrial fibrillation and high output heart failure. A simple blood test will reveal the diagnosis.

We all know that Diabetes is a risk factor for heart attacks, stroke and peripheral vascular disease. #Insulinresistance leads to these macrovascular complications even before a diagnosis of Diabetes is made!
Some simple indicators of insulin resistance include
1. Abdominal obesity (high waist hip ratio and waist height ratio)
2. Skin tags
3. Acanthosis nigricans or dark velvety patches of skin on neck and arm pits and back and hands
4. High triglyceride to HDL ratio in lipid profile
5. Large appetite
6. Hungry/sleepy/tired after eating
7. Fatigue
8. Craving for sweets
9. High blood pressure
10. Impaired fasting glucose level
#MedTwitter #heartattack #CardioTwitter
A low carbohydrate diet and regular exercise helps to combat this and delay onset of #Diabetes and reduce cardiovascular risk.


@serioustaurean @Geeky_Foodie @FastingCoach_MS @reader_wanderer @cardio73 @mmamas1973 @abledoc

Air pollution is an important and under recognised risk factor for cardiovascular events. #HeartAttack
Higher levels of fine particulate matter (PM2.5) lead to endothelial dysfunction and slow flow in coronaries and systemic inflammation, leading to accelerated atherosclerosis and thrombus (clot formation).







Before some smart Alec asks if it is just an anecdotal thing or I have any data....sciencedirect.com/science/articl…

Mysore is steeped in culture and tradition and the Gombe Habba or the doll festival celebrated during Dasara stands testimony to this.
The most important dolls are the “pattada gombe”. This is a pair depicting husband and wife/ King and Queen. This pair of wooden dolls is decorated and handed over to the daughter of the family during her wedding as a symbolic gesture for her to continue this tradition of the festival #Dasara
We know the story of how Goddess Chamundeswari killed Mahishasura and restored peace and harmony to the universe. Legend has it that in order for her to do so all the other Gods and Goddesses gave their powers to Goddess Chamundeshwari and being devoid of their powers they became statues. It is in their honour that the Gombe habba is celebrated.

Blockages causing #heartattack are not 90% or 100% to begin with. They're usually 30% or 50% narrowing only. The heart attack happens when the plaque becomes vulnerable to rupture and form a clot causing heart attack acutely. The way to prevent is by addressing risk factors like… https://t.co/0tob86a6zgtwitter.com/i/web/status/1…
Again getting confused between angiogram to perform treatment of existing blocks causing chest pain or heart attack is not the same as screening for risk of developing heart attack in a person not having these problems yet. That is where the advice to do a "CT angio in everyone"… twitter.com/i/web/status/1…

Name one test to detect heart attack risk?
Name one food to eat to prevent heart problems?
Name one medicine to take to get rid of blocks?
Can I just do one CT angio and thereby predict heart attack in future?
I wish treating and preventing heart disease was that easy!… twitter.com/i/web/status/1… The human body is a complex system which has evolved over millions of years. It is not a simple machine manufactured by us. It cannot be dealt with like we deal with a TV or refrigerator or a car!

26y old girl. Working in clinical research. Came with chest pain. ECG was abnormal. Advised to get admitted and undergo angio. Only friends had accompanied. Reluctant. Family had to come from Chennai. Finally got admitted after 3 hours of deliberation.
I insisted on admission… twitter.com/i/web/status/1… When faced with a young patient with heart attack and not so classical ECG changes, it is not unusual for duty doctors to be little unsure what to do! I would rather take the flak for doing an angio deemed unnecessary when it turns out normal than sending a heart attack patient… twitter.com/i/web/status/1…

"Patient chennagiddaara saar?" (is the patient alright?) - asked my cab driver. I said yes, but how did he know? He said he had picked me up and dropped me before too, at odd hours and realized I'm a doctor.
#Humanity
Concern for fellow beings is what makes us human.… twitter.com/i/web/status/1… Most of the time I'm busy on my phone and writing up a thread on my return home trip in the cab. I've realized most of my tweets on acute heart attacks are written like that. The half hour well utilized.

Not to lose heart. Be positive.
1. Sit tight and prepare for entrance if you're interested in PG.
2. If interested in administration get into a MBA or MHA program at a good university - believe me.. You'll be in a very good position 10 years from now, even better than clinical… twitter.com/i/web/status/1… 6. Rural service. If you're OK working in PHCs, there are several options. You can work for few years and then get PG through in-service.
7. Setting up a practice. Being a good GP has its advantages. But difficult to sustain in the long run without PG. Family practice DNB is not… twitter.com/i/web/status/1…

3am
#HeartAttack
"Tombstone" ECG - Named so aptly because if not treated in time, it maybe fatal.
54y male smoker
Chest pain since 2 hours
Emergency angioplasty done within 1 hour of arrival and stabilized.
#stentingsaveslives #MedTwitter #CardioTwitter #SmokingKills

Innashtu bekenna hrudayakke rama 1/5 #Ramanavami2023 twitter.com/i/web/status/1… Innashtu bekenna hrudayakke rama 2/5 #Ramanavami2023 twitter.com/i/web/status/1…

Lost my father after prolonged illness. Miss him every day.
Had to handle mother's serious health issues. Did her angioplasty myself after a heart attack. Later a fall and spine issues.
Saw my niece who was born in front of me finish her Masters from MIT and then get married!… twitter.com/i/web/status/1… Realized friends are your strength and support system no matter how far and wide they maybe spread. Talking to a friend or chatting to them even briefly can greatly reduce stress levels! #friendship

A survivor of #cardiacarrest. 61y old guy. Post angioplasty and stenting, May, 2022. He said..
"I want to make sure I don't get into trouble again Dr! I've seen how much stress you and your team were under when I was on Cath lab table to save my life" #MedTwitter #HeartAttack When a patient comes in with heart attack and cardiac arrest or cardiogenic shock, the entire cardiac team is put into test. Reviving the patient, talking and explaining to relatives, quickly shifting to cath lab, doing an emergency angiogram and angioplasty. Making sure the… twitter.com/i/web/status/1…

First day First ride First passenger in the line! #NammaMetro #Purple twitter.com/i/web/status/1… First ticket

"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.

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…

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 mayoclinic.org/diseases-condi…

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

https://twitter.com/vschanna/status/1598374967691063296

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.

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 ncbi.nlm.nih.gov/pmc/articles/P…