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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

13th December 2011, Tuesday

Even Samall Blockage Can Cause Heart Attack

Smaller plaques in the coronary arteries are more dangerous than larger blockages. It is wrong to assume that larger the blockage, greater the chance of getting a heart attack.

The larger blockages often cause symptoms of angina chest pain as the heart does not get enough blood when the patient exerts but this usually does not end up in a heart attack. Heart attack often occurs in an otherwise perfectly healthy individual suddenly and manifests either as massive heart muscle damage or sudden cardiac death. These patients often deny history of angina pain prior to heart attack. The average blockage that causes heart attack is less than 50% obstruction in the coronary artery. Patients with severely blocked arteries (a blockage of more than 70%) often do not end up with a massive attack.

So, if severe narrowing of an artery is not the cause of heart attack than what is it? The answer lies not on the severity of blockage but on the nature of the blockage. Blockage is formed due to a plaque. Plaques are a mixture of cholesterol, fat, fibrous tissue and white blood cells deposited in the walls of the arteries over a period of time. These deposits can vary in consistency and their proneness to rupture.

If the consistency is hard, the plaque is called as stable and if the consistency is soft and the plaque is prone to rupture, it is called as an unstable plaque. An unstable plaque irrespective of the amount of blockage is the one which is responsible for acute heart attack. A stable plaque no matter what amount of blockages it is causing is often not the cause of acute heart attack.

In a stable plaque the slow rate of growth of the blockage allows time for blood flow to develop into new arteries called collateral vessels. These new vessels bypass the blocked artery and bring the necessary blood and oxygen to the heat muscle. In some patients the arteries may become completely blocked and yet the heart muscle supply may remain normal because the collateral vessels have enough time to grow.

In an unstable plaque, with the rupture of the plaque, an acute clot forms, and as there is not enough time for the collaterals to develop the patient develops acute muscle damage or sudden cardiac death.
High blood pressure, high cholesterol, active and passive smoking are few of the factors which makes plaques more vulnerable to rupture. Other causes are negative thoughts, deep frying food etc. All these are responsible for generation of free radicals in the body, which makes the cholesterol more sticky and makes the plaque vulnerable to rupture.

These plaques which are often small can rupture suddenly and without warning. Typically such patients may have been feeling themselves perfectly healthy, their treadmill may have been negative, they may have been walking a mile a day for years together without experiencing any chest pain. Until the moment of rupture of the plaque and causation of heart attack these patients might have been absolutely normal.

Even otherwise healthy individuals can develop acute heart attack. The only answer is two-fold either to recognise the underlying risk factors which can be responsible for causation of heart attack and modify them in time or identifying the warning signals of heart attack well in time so that in case of acute heart attack the clot can be dissolved with clot dissolving therapy with reduction of mortality by 30% provided the clot dissolving therapy is started within 3 hours.

The public must know the warning signals of heart attacks and reach the hospital within 3 hours. These are uncomfortable pressure, fullness, squeezing or pain in the centre of the chest lasting more than a few minutes; pain spreading to the shoulders, neck or to the arms; and chest discomfort with light headedness fainting, sweating, nausea or shortness of breath.

Every individual in the coronary age group most have their risk factor evaluation. Risk factors like high cholesterol, high blood pressure, uncontrolled diabetes, excessive negative stress and passive or active smoking if present must be modified well in time. The; main stray of treatment now a days is towards reduction of levels of cholesterol in the blood. Reduction of cholesterol in the blood also reduces levels of cholesterol in the plaque making them more stable. They highlighted that 1% reduction in the blood leads to 2% reduction in the risk of getting a heart attack.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Even Samall Blockage Can Cause Heart Attack

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011
Divya Jyoti – An Inter Nursing School + College Health Festival.

Stage exposure for a nurse is very important to become a good communicator in life.

Dr K K Aggarwal
    National News

Gurgaon comes alive with butterflies

GURGAON: Butterflies are crucial to urban surroundings, not just for the colour they provide to the bland texture of our cities, but also because they happen to be the most significant indicator of bio–diversity in an area. These days, Gurgaon is teeming with these polychrome creatures. Various species can be seen fluttering within the bio–diversity park, which according to experts, is a positive ecological sign, especially for a city known for its dwindling plantation and its massive pollution cover. (Source: TOI, Dec 12, 2011)

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

A handful of pistachios can decrease glycemic response

couple of handfuls of pistachio nuts eaten with a high–glycemic meal such as pasta can do wonders for postprandial glucose and insulin levels, especially in people with metabolic syndrome, according to new research presented here at the International Diabetes Federation (IDF) World Diabetes Congress 2011. (Source: Medscape Medical News)

For comments and archives

Regular mammograms slash breast cancer mortality risk in half

Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case–control study suggests. According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%. The study was published online December 6 in Cancer Epidemiology, Biomarkers, and Prevention… (Source: Medscape Medical News)

For comments and archives

Decline in vision problems in diabetes noted

Diabetes–related vision deficits declined significantly over the past 15 years, according to a study by the CDC. The proportion of adults with diabetes who reported vision impairment decreased from 26% in 1997 to 18.6% in 2010. (Source: Medpage Today)

For comments and archives

   Cardiology eMedinewS

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Key Note Address: Future of Echo: Where are we Headed?: Dr Navin C Nanda

Read More

Dr P Chandwani on Longitudinal Compression

Read More

CSI Gudelines on Follow Up Of Prosthetic Heart Valves:Rajiv Bajaj

Read More

Complications of Acute MI: Arrhythmias recognition and treatment

Read More

Surgical Treatment of Mechanical Complications:Dr Pawan Kumar

Read More

How to Prevent Late Complications of AMI: Dr Puneet Rastogi

Read More

Key Note Address: Women and Heart Disease: Dr Kathryn Taubert, Switzerland

Read More

    Twitter of the Day

@DrKKAggarwal: Even the Elderly Can Have

@DeepakChopra: Obesity, Diabetes, Hypertension can cause Kidney Disease and the multiply mortality rates. My interactive Health Tip:https://bitly.com/Dpak_CKD

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Cultivating Positive Thoughts

Darkness present in a room cannot be removed physically. It can only be removed by switching on the light. Darkness therefore can be defined as absence of light.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The 99 Club

Once upon a time, there lived a King who, despite his luxurious lifestyle, was neither happy nor content.
One day, the King came upon a servant who was singing happily while he worked. This fascinated the King. Why was he, the Supreme Ruler of the Land, unhappy and gloomy, while a lowly servant had so much joy?

The King asked the servant, "Why are you so happy?" The man replied, "Your Majesty, I am nothing but a servant, but my family and I don’t need too much – just a roof over our heads and warm food to fill our tummies." The king was not satisfied with that reply. Later in the day, he sought the advice of his most trusted advisor. After hearing the King’s woes and the servant’s story, the advisor said, "Your Majesty, I believe that the servant has not been made part of The 99 Club." "The 99 Club? And what exactly is that?" the King inquired. The advisor replied, "Your Majesty, to truly know what The 99 Club is, place 99 Gold coins in a bag and leave it at this servant’s doorstep."

When the servant saw the bag, he took it into his house. When he opened the bag, he let out a great shout of joy… So many gold coins! He began to count them. After several counts, he was at last convinced that there were 99 coins. He wondered, "What could’ve happened to that last gold coin? Surely, no one would leave 99 coins!" He looked everywhere he could, but that final coin was elusive. Finally, exhausted, he decided that he was going to have to work harder than ever to earn that gold coin and complete his collection. From that day, the servant’s life was changed. He was overworked, horribly grumpy, and castigated his family for not helping him make that 100th gold coin. He stopped singing while he worked.

Witnessing this drastic transformation, the King was puzzled. When he sought his advisor’s help, the advisor said, "Your Majesty, the servant has now officially joined The 99 Club." He continued, "The 99 Club is a name given to those people who have enough to be happy but are never content, because they’re always yearning and striving for that extra 1 telling to themselves: "Let me get that one final thing and then I will be happy for life." We can be happy, even with very little in our lives, but the minute we're given something bigger and better, we want even more! We lose our sleep, our happiness, we hurt the people around us, all these as a price for our growing needs and desires.

That’s what is called joining The 99 Club!

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

No evidence of dairy and chronic disease link

The popular press has recently reported on assumptions that regular consumption of milk or dairy products may increase risk of cardiovascular disease or death. However, new research has once again confirmed after systematically analyzing 17 studies that there is simply no evidence to substantiate these claims. The evidence, in fact, shows just the opposite—drinking milk slightly reduces the risk of coronary heart disease. In addition, multiple studies show that milk and dairy proteins (whey and casein) may actually protect the heart by helping to maintain lower blood pressure, lower blood sugar, and lead to reduced bodyweight.

The renowned, epidemiologic and nutrition researcher Walter Willet, Ph.D., and his group at Harvard, conducted this huge analysis by looking at various types of dairy intake, ranging from milk intake to total high–fat dairy products and total low–fat dairy products and correlating to risk of cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all–cause mortality. This study was a meta–analysis of many prospective cohort studies in healthy men and women.

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Visual acuity and peripheral vision are evaluated in most states as part of the driver’s license renewal process. Retesting visual acuity between the renewal periods is required only if there has been a driving incident. The most common acceptable requirements are a visual acuity of 20/40 in the better eye and 120° of horizontal peripheral vision.

For comments and archives

    Medicine Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta)

Is enzyme replacement a solution for GSD

Enzyme replacement was thought to be the answer but its issues of tachyphylaxis– needing progressively higher doses and frequent infusions at almost 20–30 days intervals have put question marks over its advantage over existing therapy and its risk–benefit and cost benefit advantage.

For comments and archives

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emedinews revisiting 2011
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    IJCP Special

Dr Good Dr Bad

Situation: A re–sterilized defibrillator was re–implanted in a patient.
Dr Bad: This is unethical.
Dr Good: With consent its ok.
Lesson: Defibrillators that still have significant battery life can be successfully removed from patients who no longer need them and re–implanted in other patients. A total of 21 implantable cardioverter defibrillators (ICDs) and 19 cardiac resynchronization therapy defibrillators (CRT–Ds) were removed from U.S. patients and re–implanted in Indian patients, resulting in a 35% successful shock rate and no instances of infectious complication (Pavru BB, et al. Preliminary experience regarding re–use of explanted, resterilized defibrilators Abstract 18350 presented at the American Heart Association Meeting 2010)

For comments and archives

Make Sure

Situation: A patient with ejection fraction of 20% dies a sudden cardiac death.
Reaction: Oh my God! Why was ICD not put?
Lesson: Make sure all patients with ejection fraction less than 35% are put on ICD unless contraindicated.

For comments and archives

  Quote of the Day

(Dr GM Singh)

A man lost everything in fire, next day he placed a sign board. "Shop burnt, goods burnt, But faith and confidence not burnt. Business will start tomorrow."

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Thyroid stimulating hormone (TSH)

TSH is produced by the pituitary gland. It stimulates the production and release of T4 and T3 by the thyroid gland. TSH testing helps to

  • Diagnose a thyroid disorder in a person with symptoms
  • Screen newborns for an underactive thyroid
  • Monitor thyroid replacement therapy in people with hypothyroidism
  • Diagnose and monitor female infertility problems
  • Hhelp evaluate the function of the pituitary gland
  • Screen adults for thyroid disorders
    Mind Teaser

Read this…………………

ch poorri

Yesterday’s Mind Teaser:      b

Answer for Yesterday’s Mind Teaser: Crossbow

Correct answers received from: Dr KV Sarma, Dr Prabha Sanghi, YJ Vasavada, Dr K Raju, Dr Sudipto Samaddar, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr BB Aggarwal, Anil Bairaria,
Dr Neelam Nath, Dr HL Kapoor, Dr KV Sarma.

Answer for 11th December Mind Teaser: Their letters are in alphabetical order.
Correct answers received from: Yogindra Vasavada, Dr Avtar Krishan, Dr Thakor Hitendrasinh G,
Dr Chandresh Jardosh, Dr Harkanwaljit Singh Saini, Dr Sukla Das, Dr PC Das, Dr Neelam Nath, Dr Smita, Dr Heena, Dr Sanjay, Suman Sharma, Dr K Raju, Dr Deepali Chatterjee.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Broken Window

There was a knock at the door. It was a small boy, about six years old. Something of his had found its way into my garage, he said, and he wanted it back.

Upon opening the garage door, I noticed two additions: a base–ball and a broken window sporting a baseball–sized hole. "How do you suppose this ball got in here?" I asked the boy.

Taking one look at the ball, one look at the window, and one look at me, the boy exclaimed, "Wow! I must have thrown it right through that hole!"

  Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

The injuries produced by a blunt weapon on tense skin covering the bones, as on scalp, eyebrow, iliac crest, shin, perineum, knee or elbow looks like incised

  • During the preparation of MLC report the doctors should keep in mind that he has to provide clue about the weapon used is sharp edged one or otherwise, the direction of the force, the duration of injury, and the location of the wound which may suggest mode of production i.e. suicide, accident, homicides along with whether the injury is fabricated or otherwise
  • The wounds produced by a blunt weapon or by a fall on the hard surface, object, on tense structures/skin covering the bones, such as the scalp, eyebrow, iliac crest, shin, perineum, knee or elbow when the limb is flexed looks like incised wound however it is lacerated wound also called split laceration caused by blunt force and create confusion in the mind of doctor public and police official about sharp weapon.
  • When the incised looking wounds are examined by doctor under magnifying lens the edges of such wounds are found to be irregular with bruising and wounds are produced by blunt weapon.
  • The wounds which are also produced by pieces of glass, broken crockery has the characteristics of incised wounds but the edges appear parallel with one end of the wound an injury to a finger/body as a neatly incised laceration/split laceration or incised looking wound caused by broken glass "Neatly incised laceration is considered as incised wound and these broken glass as dangerous weapon.
  • An incised wound, cut, slash, and slice is a clean cut through the skin may or may not underlying tissues and structures caused by sharp edged instruments, which is longer than the depth of wound. It is produced by infliction of an object having a sharp cutting edge such as knife, razor, blade, scalpel, sword over the body.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Women above 65 to take extra care of their health

Women aged 65 and above should take low dose aspirin routinely to prevent heart attack and paralysis, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

  1. All women are urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate–intensity activity on most, or preferably all, days of the week.
  2. A heart–healthy diet should be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
  3. Saturated fat should be reduced to less than 7 percent of calories.
  4. Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL.
  5. Women aged 65 and over should consider taking low–dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group.
  6. The upper dose of aspirin for high–risk women is 325 mg per day.
  7. Hormone replacement therapy, selective estrogen receptor modulators nor antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
  8. Folic acid should also not be used to prevent cardiovascular disease.
  9. Women should eat oily fish or some other source of omega–3 fatty acids at least twice a week.
  10. Women should not only quit smoking but should use counseling, nicotine replacement or other forms of smoking cessation therapy.

For comments and archives

    Readers Response
  1. Dear Sir, Well informed Newsletter. Regards: Ridhi
    Forthcoming Events

Lecture on Buddism and Astronomy

By Prof. Trinh X. Thuan

UNESCO Kalinga Awardee, 2009; Prof. of Astronomy, University of Virginia, USA; UNESCO Kalinga Awardee for Popularisation of Science by UNESCO, Kalinga Chair awardee by Department of Science & Technology, Government of India.

Organised by Heart Care Foundation of India in association with Nehru Planetarium on behalf of RVPSP, Dept. of Science & Technology Govt.of India

At Nehru Planetarium Chankyapuri New Delhi on 27th Dec 2011 at 10.30 am

No fee, to register email to drkakroo@gmail.com, 9810301261

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews "Doctor of the Year Award" function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

3rd eMedinewS Revisiting 2011

Dr Ajay Kriplani (Surgical management of diabetes); Dr N K Bhatia ( What’s new in transfusion medicine); Dr Kaberi Banerjee (Fertility update); Dr Amit Bahrgava (Cancer update 2011), Onco Radiation update (Rajiv Gandhi Cancer Institute); Dr Ambrish Mithal (Vitamin D update), Dr Praveen Chandra (Interventional Cardiology update); Revisting 2011 (Dr K K Aggarwal), Portfolio management (Central Bank of India); Insurance update (LIC India); General Insurance (Doogar Associates)

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta