why heart attack is happening in young Indians people are confused that he is fine okay tomorrow all of a sudden he has a heart attack and they die have risk factors right from any age maybe around excessive chiming or aggressive workout so heart attacks can happen in Marathon rers heart attacks one of the most important preventable factor is smoking so that is the one message only if it goes through all of this quit smoking younger patients there's no benefit from it the risk is Multiplied smoking kills you why there is increased heart attack in patients in South Asians India Pakistan Nepal Bhutan Bangladesh Sri Lanka the problem with our Indian Community is this abdominal compartment is small should every person should know at least how to do CPR trying to educate because CPR saes life working night shift puts an undue strain on the heart isn't it it is a and I think so it's very important to say stop when the body says please stop yeah exactly listen to the body in your practice when you talk to people is lack of sleep is a common thing it is more mobiles while sleeping also continue to see their Netflix and Amazon I think so more than anything else proliferation of OT channels you know wider availability so much content so much content and it's addictive over a period of time eats into your sleeping [Music] time hello guys welcome to another episode of our podcast series gut feeling with Dr pal in this episode we have my friend Dr ano dande who is a very popular cardiologist in Mumbai has been putting stance in the hearts on a daily basis we talked about a lot of things about acute heart attack why are people having heart attack at such an young age and why people are actually dropping Dead who are completely normal the day before what is the reason behind it what can we do to prevent this and what can be done while the heart attack is happening so that we can actually save lives some tips and tricks for you to actually adopt and you can actually save a life if your friend or a family member is having a heart attack right in front of you how to diagnose it what are the symptoms and what are the treatment options more importantly we discussed about how to prevent it what are the lifestyle measures that you should take and he himself shared some personal stories about how he takes care of himself being a cardiologist how he takes care of his heart it was a wonderful episode let's dive deep into it hiop hello hi again thank you so much for coming back again thank you so much pleasure is all mine so you know we had a wonderful discussion last time wonderful discussion we talked about heart disease how heart disease is formed what are the risk factors how what are the things that can be done to prevent the heart attack yes right now we are going to talk about the most pressing problem yeah why heart attack is happening in young Indians W sudden cardiac death people are confused that he is fine okay right tomorrow all of a sudden he has a heart attack yeah and they die right and we we're looking you know 25 to 35 years right old people right um what is the most important reason for this right so very pertinent point for my younger patients for my younger audience heart attacks heart attack look they don't look at any age so you get attacks right from you have risk factors right from any age maybe around 20 onwards you say as young as 18 huh 18 also 18 18 also do you remember that patient what was the patient about yeah so he went to gym gym yeah he was a Jim so probably in that case the ideology the risk factor might be different uh as a medical practitioner we are all aware excessive chiming or aggressive beyond the [Music] limits high intensity can lead to small dissections possibly that's why we hear so many celebrities hardcore prolonged jimming not listening to the body at times marathoners 40 40 km collapsing last moment what happens is like some dissections in especially the younger crowd aggressive when they're doing workouts small dissections like small flap which forms inside the innermost layer of the hard blood vessels endothelium that small dissections when exposed to the platelets can form a plug in an patient who is at risk of not everyone gets it correct but who is at risk genetically predisposed and other factors are also there so that platelet plug which is formed inside a vessel which is small wear and tear or dissection can lead to sudden clot formation and leading to a heart attack heart attack okay so summarizing is the lining of the blood vessel is damaged to start with start with very veryable and then when you do an excessive workout it can lead to small dissection H dsection is disintegrating like this disintegrating of the blood vessel innermost layer but that can lead to Plate plug formation and that sudden platelet plug formation can lead to a major attack platelet is the blood clotting mechanism of your body and that cell can get attracted to this dissection and forms a complete block that is in a special scenario we're talking about an 18 20 year old aggressive Jimma otherwise not everyone obviously can't equate the everyone going to gym is going to have this no someone has to be gener so we can repeat that statement again that the point is that you should not go to the gym the point is there are certain group of patients they are at slightly increased risk when they are doing aggressive workout which they have not done before right that could predispose to this PL plug formation yes while we are in that discussion you heard about the Garba attack yeah Garba uh in Gujarat no so they we don't talk so in Garba people were dancing yeah and then all of a sudden everybody died they were dancing for hours together six to eight ah dehydration exertion yeah and uh so that's what possibly happens in ultramarathons marathons so so so let me refr the question so heart attacks can happen in marathon runners heart attacks do happen every year in Bombay we have the standard chattered Marathon which is approximately 40 42 kilm uh in humid conditions of Bombay someone who's not well trained well hydrated uh what happens in during that extended period of exertion the blood pressure the cardiac output heart functioning remains an extreme high can lead to formation of that small dissections we talked about but apart from that the dehydration there's a cell concentration inside the blood vessel that dehydration cell concentration sticky platelet small disection everything can lead to small blood clot formation which can lead to attack so it's very pertinent that you keep yourselves hydrated that you having proper workout and a proper schedule when you train well rather than jumping directly ah extremely important so it doesn't happen on all patients and even when that happens it can be prevented by proper well trained schedule it doesn't mean that you should not run marathon at all absolutely not because physical activity is very important physical activity is extremely important but uh again you have to train yourselves well the conditioning has to be there you don't jump into something without any preparation without any training and important is to keep yourselves hydrated and again listening to the body is important if you feel discomfort down no shame in stopping no problem yes yes rather than pulling on and on correct so every year around 5 to 10 patients in the whole Marathon fall sick one to two patients casualties do happen so important message is nothing should stop you from doing that m but listen well to the body prepare well keep hydration at hand and if you have any discomfort please stop M it's important so young patients we talk about gyming correct we talk about marathons but apart from that these are the minuscule population very minimal minimal so we don't focus on it here but when we talk about the major risk factor in younger patients again as we talked about in the pr previous episode Indians do get corat disease 10 years earlier than the Western counterparts multiple reasons multiple factors younger patients in India tend to suffer and one of the most important preventable factor is smoking so that is the one message only if it goes through whole of this quit smoking younger patients there's no benefit from it but the risk is multiply smoking kills you smoking kills it's hazardous Rao so if I do angioplasties primary angioplasties a younger patient less than 30 35 you can say 35 years less than that 90% more than 90% of them would be smokers that's the most important risk factor more than 90% there are certain fact uh genetically predisposed you can say or at times dietary you can say if we had if lot of patients B12 deficient that leads to a factor increased hyper homosysteine the homosysteine is increased that hyper homos symia can cause can lot cause lotos thrombosis aggressive thrombosis so we had patients is it right no risk factors hyper homos symia High homoy deficiency vegan almost vegans vegetarians leading to that so again calls for taking that supplementation properly correct because uh most of them are smokers we can identify hyper homos symia in certain group of patients again very minimal yeah but again the gmers and the marathons are very very minuscule but then young patients they all count so you should be taking into consider ation but one thing the message should be clear you should do your physical activity under supervision the diet should be powerful and the smoking is an absolute no no must no I had a patient who had a heart attack and then he was smoking and then I said why are you smoking and I said my doctor said smoking causes cancer he never said smoking causes heart attack that's a very funny statement but I think uh that's that's one of the main important things should be very clear there is a advertisement was a wonderful creative advertisement where the patient the guy smokes and then he falls had a Syle attack kind of thing he uh falls down on the floor unconscious and the smoke is basically uh the cigarette is lying on his heart oh and then slowly it is disintegrated so that's one of the Beautiful Things the other thing that I like about this creative advisement smoking is smoking causes importance it is huh so they show the smoking and the smoking goes like this right so there is uh one saying in cardiology erectile dysfunction ere dysfunction is preceded by endothelial dysfunction we talked about the endothelium yes yes so Ed is Ed that predates that so before you get anything you have endothelial dysfunction which someone has an endothelial dysfunction High chances he will have a patient with aital dysfunction has endothelial damage the same endothelium can also be in the heart and can same so endothel what happens is it releases nitric oxide which is dilator we know that which is important in uh uh the patients with erectile dysfunction but endothelial dysfunction is the first wow you can say this dysfunction to happen before this is an end product endothelial dysfunction is at the heart of this itti dysfunction as well wow Ed is z wow that's what we say Ed is while we are in this discussion yeah U so it's very clear that young people are at increased risk of heart attack because of multiple stress and all those things we talked about but more than that yeah um the our South Asian Community is at increased risk right so I am I a part of very I play a small role in a study called Masala study okay okay it's called masalah m a s a l a right ma a stands for metabolic Associated sa stands for South Asian as okay La is Living in America oh wow Masala Masala nice wow Masala study yeah what this study is focusing on why there is increased heart attack in patients in South Asians India Pakistan Nepal Bhutan Bangladesh Sri Lanka okay and as you know like similar to me there are so many people migrated from these countries into us so they are studying why are these people dying of heart attack having heart disease more than the white people yes okay so we found out three reasons right so number one when we are born right there is a hypothesis called Thin fat Indian baby hypo yeah you heard of it yes but Indian Paradox I have heard of it Indian Paradox indan thin Indian Paradox thin indan par so uh I'll come to that okay yeah this is when you're born yeah when you take a low birth weight I mean when you take two babies yeah Indian South Asian baby yeah white baby so let's say both are three kilos right with the same weight the body fat percentage is higher in the in baby yes same weight and that progresses into adulthood and that is where we end up in get skinny fat right as exactly as you say Indian obesity Paradox is we call it tofi t fi uhuh to stands for thin on the outside outside fi is fat on the inside tofi tofy tofi right then what happens is the as you know when they eat more calories more cops cops are going to convert into fat the first fat accumulation of adpost tissue is right beneath the subcutaneous tissue the abdomen abdomen after that once it gets filled up it spills into the visceral fat inside the abdomen deep inside the abdomin around the organs the problem with our Indian Community is this abdominal compartment is smaller smaller significantly smaller smaller compared to other non Western counterparts so you don't have that much room to store in just subut tissue you are absolutely Li I mean uh predisposed to throw the excess fat into the viseral fat viseral fat and as you know viseral fat is seat viseral fat is the seat of insulin resistance metabolic syndrome to start with we have a problem yeah so which means we need to be extra cautious extra cautious and aggressive that's a very wonderful Point yeah extra cautious extra cautious so the genetics remain the same even if you are in us correct the predisposition Remains the Same so you have to be extra cautious so we should decrease the Masala the masala that's that's a wonderful so so we were I mean there there still the research is going on they're finding so many new things they found out that there is uh 20% increased risk of diabetes in this people yes compared to Western counters even with a normal diet I mean the same amount of diet so there are lots of research that's coming out but bottom line is we Indian Community needs to understand that we are at an increased risk of heart disease compared to any other eity exactly number one number two coming back to the same situation where the young patient is having an heart attack um so I this is my neighbor yeah okay my neighbor we both went to actually uh I mean my son's birthday party was the next day mhm me and my neighbor my neighbor was 36 years old okay see we both went to the grocery store to buy all this decorations and all those things in the grocery store he passed out oh he passed out he complained of chest pain and he passed out and I I I tell all these stories and I myself very surprised that why is this happening to me all the time M because I am seeing that patient passing out right in front of me so I check the pulse there's no pulse oh there's no PSE so we end up doing CPR CPR ah we doing CPR and then the grocery store has an AED machine manag to defate ah luckily that there was an ambulance right uh next street or something so they call 911 which is the number to call and then they came they did the cardio version I mean CPR um they shocked him yeah and the pulse came back wow fantastic yeah massive heart attack massive yeah massive heart massive so I want to ask you should every person should know at least how to do CPR wow that's that's a fantastic uh thing you know we are in the process the Cardiology Community especially in Mumbai in India I think so handson CPR training we do uh take out time and uh try to go to the communities to the societies with manics we're doing that trying to educate nice because CPR saves life it saves life right the cardiac massage unfortunately we don't have defibrillators the shocking devices installed but we are uh trying you know the initiative is there to get it at least at the public places raway stations are getting them the gym should be getting them the Housing Society should be getting them so I think so in the longer run you have the CPR trained personnels they actually save lives save lives so I think it's it's the need of the r and uh with you know have mushrooming of catlabs uh where you can actually do procedures but the point is if you have a fatal heart attack and near death situation I think CPR and defibrillation saves saves so we have the ABC of resuscitation Airway breathing and circulation the D is defibrillation so defibrillator machine should be encouraged in public places in malls in theaters so the D should be before ABC that's what we say CPR so ABC of CPR is Airway breathing and circulation but we actually trying to get the D in front of a so you have P SP defibrillator and then start with the massage so let me just summarize what you said is that um CP are is the cardiopulmonary res cardio pulmonary res cardio is heart pulmonary is lung resuscitation means both are almost dying please resuscitate resuscitate so the common teaching is that you press two finger two hands yeah uh like this low part lower part of the sternum and then you keep pressing and we will put that in the description in terms of you know what to do yeah uh and while you're doing this you're doing massaging the heart massaging the heart actually trying to what happens so what happens is like what we try to do is uh while trying to do a CPR and putting pressure in a proper way obviously the sternum should be lowered and at the same time the heart is manually compressed and that gives just enough adequate cardiac output or blood supply which is you know uh adequate enough until the patient get the hospital get to the hospital so we continue the CPR in the time pulse is there and the blood flow and most important thing is the brain the blood flow of the brain so the most important thing about CPR is to make sure with the CPR with whatever massage that you're doing in a proper way the blood flow is adequate enough at least the brain is perfused ultimately you treat the heart attack but the brain is gone you've seen patients like that many many many where where there is heart attack you save the heart the brain is gone pressures are okay everything is okay after that the brain doesn't come up brain doesn't come back doesn't come back so it's important that if brain doesn't come back they cannot remember who they are absolutely almost comat coma comat so I think so that's a very s St H because of the heart attack heart is not able to pump blood so the brain didn't receive any blood so heart can sustain without blood flow one of the portion of the heart muscle maybe for we talked about the golden gold hour 60 to 90 minutes but brain just gives us 5 minutes if there is no blood supply to the brain I think so it's a very scary situation scary situation yeah so CPR is must C we should be inculcating more educational programs um and more public awareness through various Medias to encourage people to take up that training we give the certification course also so any day person who are actually attend the program and given a certificate as a CPR training so obviously defibrillations again it should be state sponsored but they should you know make that so is it available now not as much it's far and few in between far yeah so even malls crowded places shopping mall should definitely have it yes I think so it should should definitely have it every floor should have it every floor should have every floor should have it yes I think so airports have it but again I see it not so frequent you to travel like a kilometer before you get to the defat which is at one of the corners I think so more as compared to other countries I went to Japan or us us they are everywhere widely available widely available avilable so I think through this forum I think so we can make and probably that we can have CPR machines we can uh make more you know people aware maybe we could spread the message to the audience who are watching is that if you want to donate or if you want to do some charity work please go to a shopping mall yeah buy a defibrillator machine give it to the shopping mall owner and then say install this in one floor one every Flor you will save so many lives so many lives I think so it's very important we do a lot of CPA training here on the manic wiins and uh any society needs a to go and help them out you know in us there's a new machine called Lucas machine yeah I know you know yeah it's it's automatic automatic CPR you're lazy but maybe you know I was so surprised someone but actually it helps it's pretty good good and uh Lucas helps when summize for the audience Lucas is a machine that gets trapped onto the chest so that you don't have to press the machine presses for himself right so again not very widely available in India but in patients who need prolong CPR till the time they go to the hospital in a proper way so there's always a fatig coming in if you only one or two people and you need it for 30 40 50 minutes machine works I think so so um so yeah so in that patient so we know we did CPR and then we took the patient to the uh ER emergency fantastic within 90 minutes yeah 54 door to balloon yes what do they say door to window door to balloon door to balloon yeah ballon is a stand so door is er er door to the balloon was only 40 minutes fantastic I think so that's a great so the cardiologist was on call went in 100% blockage of the left artery wow and then they put a stent in you will not believe the patient he woke up woke up and wonderful went home third day probably first of yeah I think so the whole thing is our job is easy to put in an stent balloon cardiologist but the important thing here is you got the patient to the hospital through CPR doing a CPR and defibrillation that's the most important thing correct correct without a CPR and Def he would never have he would yeah yeah yeah and this uh so once a CP so that at that time yeah somebody was mentioning me that hey did you have this emergency heart attack kit with you I said what is that he said no oh you know any we do aspirin Statin cidal what is that kit not heard about that in us I think so I'm not a big fan of all these medications to be kept in uh someone said like someone is getting like poping some sorbitrate patient might be having low blood pressure or hypotensive that sbit may actually worse so it doesn't work that way it's not so simple arith mic m H uh but yes in some doubt if you are in periphery kit I don't know but aspirin clil we give it till the time a diagnosis or ECG is established if the patient comes to an ER or if the patient is getting transferred without an ECG with chest pain we gave the benefit of Doubt and load the patient in ambulance only with aspirin kogal if there is an probability that he is having pain and it could be PC but uh can be generalized it can't be generalized the problem is it I feel so bad or maybe I should have had it okay good it's not generalized it's not a generalized idea okay it's not a generalized idea I guess so then you know you get a CP and then put this tent in um and then he came back and in the hospital he was emotional of course yeah you know the whole family was crying and uh it was very emotional and then he was uh saying that uh what could I have done to prevent this you know it was almost like a near-death experience near experience then I said what are you talking about you didn't know about what you were doing you know you didn't the I've been telling you repeatedly to slow down you have been working like crazy uh you have not slept well you kept on meeting the time demands yeah and the most important thing that happens either ways is you know you our Indian I'm just talking about software Engineers because my friends are all software Engineers so they work at nighttime to handle with the Indian C clients and the Indian software Engineers work for us clients again at the night time night time working night shift puts an undue strain on the heart isn't it it is it is a fact your body needs to rest needs to rest yeah you need to have that work life balance which is very important very less talk about I think so Stress Management by any form either you do breathing exercises meditation yoga vipasana very important strike that balance eat well you work what is needed and I think so it's very important to say stop when the body says please stop yeah exactly listen to the body listen to the body listen to the body as a younger individuals we usually try to punch much above our weight of course and trying to do himman stuff no I can do many things that's the beauty of being an Indian try to because we have survived in any situation yes it is we have hustled hard we know it is surval of the fittest yeah and to a point that's why in all top 30 software engineering companies it's all Indian people Indian people Indian people but during that time we have pretty much lost yes uh a huge compromise that we have made with the health huge compromise and it's for the most productive member of the society most productive member of the family which who suffers family suffers so most productive member gets it so when you are doing that extra shifts when you're doing the long night shifts without allowing your body to rest I said sleep is extremely important and undervalued you're not talking about like one day two day one month it's happening over a prolonged period prolonged time we are extra ambitious one year three years I'm telling you all the all this uh big startup companies yeah they are huge demands huge demands and they get paid very well they get PA very well it comes with a compromise but you should know the extent of means that you want right we never know the boundary right knowing the boundary and just prioritizing your health a little bit will will make you it's very important the westerners prioritize their health over everything else we tend to prioritize the material means over health over the work over everything else us they don't most of them they don't work anytime after 5 six P we work hard we are we are designed to work hard we are designed to work hard that's the point we actually are we grew up our mindset is like that yes and it's very clear you know in anywhere Indian people we work hard Asian people we work hard have so I think that my request is just to understand that there's a compromise and maybe doing a little step every day yes will create some kind of maintaining that balance prioritizing health I think so that should be the takeaways and listening to your body listen to your body so that patient was asking me he went to India yeah like a month ago and then he took Master Health checkup Health checkup PL Master Health checkup so in master Health checkup there are like so many good things you know cholesterol level they check if you are diabetes they check your eye level they check your a andc level what is the thing that should be in should we include anything in the master Health checkup for your heart standpoint I think um very important so for a 35y old uh if there are no complaints we usually do an EKG ECG ECG 2D Eco and stress test but again as I said stress test is a matter of probability uh if you have the risk factors it's slightly positive you investigate further treadmill is a screening test it's not a short short test so lot of false positiv there are false positives there are false negatives negatives so we had situations where the patient had a treadmill done last week normal well next week comes with an MI it's Mi is my infection or heart attack for the general public so nothing is you can say 100% sure treadmill all these are screening tests but still it's worthwhile to check to check because you gives you a lot of confidence but let me argue that in a way in in US yeah yeah the guidelines are not recommending to do stress test in Echo yeah so are we doing this over here because the prevalence is higher uh well that's also there prevalence is higher uh and also the the likelihood of misdiagnosis might be higher as well yeah the prevalence is high and availability is also easier easier that's important correct so I want to make a very very important distinction yeah let's say you are very healthy yes you know that's a problem yeah unfortunately in the people that I've seen in and around my neighbors my friends my family and within my circle it's a very limited Circle but let me our community people they belong to two ends one they're extremely fit they're very health conscious they're 10 out of 10 and they are like fit muscular the other is we live only one life okay give me the Biryani and the be I've seen only very minimal people in between they are there but not a lot so the problem with this master Health checkup yeah is this beer and belly group Biryani group they are not going to go to the master checkup right the people who are going to the master checkup is 10 out of 10 so they're very conscious they want to make sure everything is okay everything is okay you're not going to find heart disease in this patient that's a paradox right a paradox it is it is so I think probability is you talked about so the more health conscious you are the more likelihood that you would be choosing to go for health checkup checkup but in general everybody should get their lipid profile checked everything and the basic thing should be done I think so the basics should be checked uh lipids the sugars uh CBC basic test but CBC thyroid thid yeah everything should be checked at least once a year that's uh and after the age of 45 for males uh for females and 40 after 40 for males you should try and do it we do it treadmill and all every once in two years if family history is there even more that increases risk frequently but uh it's worthwhile because you at times detect a lot of uh things what is your take on this CT calcification wow okay I think so H let me tell you the current situation the US okay so in us you know how it works right you cannot go to a radiology department and then say okay no give CT scan right they'll be like where is the insurance because it's like 3,000 $4,000 yeah and the insurance you submit a request why do you need a CT coronary calcium you're very healthy you're only 40 years old we will not approve it yeah so then we cannot pay the money of $4,000 you know what we do we come to India do it C Calum scoring we do the CD Calum scoring for like 5,000 r000 much cheaper yeah it is and we get the results yes so many people have done this yes okay my question is right okay let me um Let Me Tell the audience that CT calcium score is you this a CT scan of the heart and remember the blockage that we discussed before uh of the blood vessels that whether it is calcified or not will be determined by the CT scan yeah in your practice will you recommend yes no what does it take yeah so I think so CT calcium scoring uh I think so you would be very happy right if you have a c calcium scoring of zero yes there's no calcium at all yeah so Calum is a marker for corat disase whenever there are PLU inside the blood vessel inside the blood vessels Whenever there are blockages or stenosis calcium gets deposited and that's easily visualized and the radiologist have uh calculations whereby they certain this score is so and so so you have high calcification means the stenosis or blockage inside the arteries is high enough to deposit calcification so that's an indirect marker secondly I think so if you get a score of zero you will be happy uh if the score is high 400 400 plus uh what to do you don't have symptoms so whether to do an angiography I think I would recommend yes I think I would recommend if the calcium scoring is high because the blockages are there and the calcium is deposited on top of itre correct but not necessarily again I will say because see as in seen go through so many scans but not necessarily that high calcium would mean that you will need a bypass or we will need an anoplasty at times it's on the Advanta or the outer layering of the vessel wall also which can also lead to high calcium scoring and if your Lumen or the vessel Lumen is fine you don't advice okay so but it's a good screening test for detecting uh the percentage of calcification which indirectly indicates the percentage or the burden of atherosclerosis or plaque blockages inside yesterday just just yesterday I had a 65-year-old Charming lady no complaints no complaints despite digging no complaints treadmill done positive in a master Health checkup as you said I see so that puts me in a dilemma whether we should do ano or not patient has no complaint absolutely no problem Master checkups test is positive that's the problemy of doing checkup right now she has done it how can I assert huh whether she has now I mean catch 20 I went to a Tre last month so and so place no complaints now the the patient is saying that she went to a trekking last time last month 65y old no complaint so you said trekking because that is an indirect version of stress test stress test because you are climbing up no complaints TR treadmill is positive very interesting what do you do no what to do uh I know judging at times people are too Keen to do an ano I can do an Ango also based on the treadmill no problem but since no complaints I thought of doing a city calcium scoring fortunately are the city calcium scoring despite the treadmill which was positive which indicating something might be there the C score for our age matched with the age controls is very low so so you said probably it is false positive Let It Be we'll do something Whenever there are symptoms right now we don't treat the treadmill we don't treat the ACG we treat the patient you not no complaints forget the treadmill for a while the CT calcium score is another test we documented is on the Lower Side you are okay so I think so it gives you lot of assurance when the city Cal score is zero but the message is don't be overly panicked if it's high doesn't mean you're going to go for a bypass till the time we do an angiography it can happen it correlates but it's not an absolute correlation that's important that's not an absolute correlation calcium score is high you'll get everywhere blockage no it might indicate indicate might indicate so it's an indicator indicator so um so that patient Hees C calcium score yeah calcium score was intermediate intermediate yeah 200 300 200 and then they recom actually they recommended anio an uh they recommend an he was like I me symtomatic I should be so it's a very very but he was pretty big yeah okay and uh he was had a big belly as well so because I was involved in Masala study I know that belly fat Bell increases the risk of heart attack especially in Indian Community right because of the abdominal adiposity adiposity I want to ask you yes you've seen so many heart attack patients so many what is the percentage of people having belly fat I think so almost 7 80 70 80% more than that maybe so belly fat causes heart attack Vis fat that a seat what you can say of insulin resistance that is seat of metabolic syndrome so I think so that's a Crux even your weight might be 60 but your belly fat and visil fat as you said nicely described is high and that's where the problem is you have a normal weight normal weight normal weight doesn't mean anything your Indians are Mal nished Mal nourish I I would say anything uh which is not balanced is Mal nourishment not under nourishment Mal arment they might be eating more but still they are maled and they have that high osity with normal weight so I think so that calls for attention and yes viseral fat the belly fat the high we look at the waist hip ratio yes rather than just is like an just an uh weight is weight is a number correct look at the waist hip ratio look at the waist circumference circumference look at the viseral fat and then decide whether the patient needs to be treated aggressively and most of this patients as we talked about the dis liid part yes the moderate to high LDL very low HDL and very very high triglycerides triglycerides everything is coming from there coming from there yes and so that patient had a stent right St huh um he was asking me will I get this again wow right I think so there are after an anoplasty there's certain dos and don'ts dos meaning you take your blood thinners very religiously you take your statins very religiously so that there's no new plaque formation inside the when you say very religiously you cannot even miss a day yes for blood thess initially 6 to9 months you should not miss you should not even miss a day you miss a day that's very important statins again to prevent any kind of plaque progression inside very important and whatever the medications needed as per the diabetes or high blood pressure anything for the low heart pumping also needs to be taken apart from that don'ts I think so very important is TOS are important don'ts are like obviously the diet lifestyle stress relief measures sleep everything has to be you know not compromised upon and there are certain operator dependent also factors again has to be I I believe most of the has do excellent job but still there is some but in literature what is the percentage uh of inant thrombosis inent thrombosis is something like clot formation immediately or within 6 months 9 months of the the risk is around 1 to 2% instant thrombosis instant but inside blockage forming inside the stent is instant restenosis the incidence of that is approximately you can say 10% or 10 years h 10% 10 years approximately so so if you don't take care of it the percentage will can go up despite doing the best of the things despite putting in a drug looting stand the best possible one STS can fail if you are not compliant if you don't take medications your lifestyles are not ather to and U obviously the risk factors remain then you can so we we we we talk a lot about risk factors yeah as a cardiologist if you have to prioritize all these risk factors prevention which one will you say the first one okay number one is Sleep Number Two is physical activity number three is low cab diet and number four is stress relaxation ah I think so I will start with a diet first diet first diet first we talked about mindful eating in the last episode I think so that mindful eating is extremely important weat is ultimately what they say in the general Notions 80% of what you eat and 20% of physical activity ultimately the calorie deficit will lead to some weight loss over a period of time uh I think so 80% I don't know maybe certain individuals might be more but diet important second I will say physical activity but not to be lost is very important sleep very important is sleep at at least try to get that 6 to seven hours in your practice when you talk to people is lack of sleep is a common thing it is huh it is an epidemic it's an epidemic it is an epidemic in India it is people are hooked to gadgets hooked to uh gadgets mobiles mobiles while sleeping also they continue to see their Netflix and Amazon I think so more than anything else uh the proliferation of OT channels you know the wider availability so much content content so much content and it's addictive you don't stop at one I think so that over a period of time eats into your sleeping time because ultimately you have to go to work correct it's not a weekend every day right so it's it's your sleep you have to go to job your mental framework work is not right cumulative effect of this sleep deprivation has lot of metabolic issues health issues leading from that and it's an I think so if you don't get adequate sleep lot of inflammatory changes inside the body it becomes pro-inflammatory which could be assessed by different markers and uh that plays a role in sudden uh worsening of your existing cardiac condition possible so I think sleep is undervalued under and as they say having adequate sleep is uh not glamorous anymore yes of course I think so need to prioritize so talking about lack of sleep right yeah the worst people yeah who was not prioritizing sleep yeah is us it is you can't actually or doctors doctors because uh we carried out this was a small survey which may not hold which may not hold true for General but uh when you look at uh 100 Health Care Professionals professionals nurses doctors uh the risk of factors earlier onset of Cor earlier doctors tend to have health issues especially the cardiac ones 5 to 10 years young earlier lifespan of a doctor is less as compared to general population we give lifespan to other people our ours I think so it's important to look inside and um at times we can't uh do away with the mobiles and all because of professional compulsions but but I think so M needs to be made there was a news that a Gujarat cardiac surgeon yes he died at the age of 40 earlier than that I guess ear that 38 the news was wonderful surgeon did 40,000 surgeries he worked so hard and I can't believe that he the reason that he died is because probably he worked too hard right we glamorize hard work that's what say we glamorize that and we don't glamorize adequate sleep at all correct the priorities the society he's working hard beautiful but I think so that thing has to be uh carefully uh carefully balanced carefully balanced carefully balanced as a healthcare professional for all young cardiologist coming up to me I always say ah don't do that unless it's necessary unless you jumping for one place it happens it's not like Bombay the practice is different corre you jump from one place to another to the third to the fourth un money money you don't Sprint it's a marathon it's a marathon for young healthc Care Professionals you have to run a marathon you have dedicated so much of time and energy to pick up a skill in the like maybe 13 14 15 years you actually invested so much of time and efforts to get that skill set you do marathon you are not here for 100 met Sprints correct you'll fall and it happens all the time I'm very concerned about the young doctors who was in training yes you know when we were in training in US was we used to go at 7:00 a.m. in the morning yeah and then come at 1: p.m. the next day so what people over there they said was you know this is not humanly possible you know they are concentration focus is going low these are all young doctors we need to preserve them so they removed the extended hours extended hours uh so acgme which is a graduate medical education they said that okay this is something wrong so we're going to do only 24 hours and as soon as the report was out we were like did did they see what is happening in India what what what they guys doing we just cannot accept the fact that they have reduced the hours because there is something new to us right so later while we were doing it because we I did 36 hours right and I can't let the other people do only 24 but I started realizing that their quality of life is much better yes much better and they were able to focus more on the studies and everything um so I think as a working doctor right after you finish your residency you can make your own choices but during the PG training undergrad training some people you cannot do it that's a system limitation I hope somebody listen to the podcast and changes the system limitation and says hey you know nobody should not work more than 24 hours exactly exactly we all went through rigorous rigorous training I think at times brutal training you know but uh yeah that was the need of the r because the PG seats were less yes now the PG seats the postgraduate seats have increased I think so twice or Thrice the number that was before so the program should be designed and it should be scheduled correct in a way that is comfortable for the training doctor well so that he gets adequate training but at the same time he gets to time to focus on his health correct studies and academics as well correct and everything everything together together I think so it's very important very important and these doctors um right now let's say the system limitation we can't do anything about it the government should do something yeah but let's say within the limitation I strongly urge all the young doctors who are seeing this H podcast U to somehow compensate let's say that you are working long and you are not able to do you can compensate by focusing on your diet mindful eating as you said and then maybe whatever sleep that you get you just focus on the Quality quality of sleep and maybe you know instead of taking the elevator take the Steps step yeah yeah small small steps small small step meet to 10,000 steps per day something like that all this will help yes will help so instead of saying that you know this is system limitation I can't do anything at least we can try at least we can try and do from our side start with eating do the physical activity whatever is needed and most important try to get that beautiful 6 hours of sleep very important most important question as a cardiologist yes how do you take care of your heart so Frankly Speaking uh six monthly I do my blood test that's one thing okay once in a while I walk on the treadmill so tread in the sense in my own Department I do my stress test that's one thing uh I try to on off days I try to be away from the phone as much as I can let it lie in one corner somewhere but it's not always possible limitations of the job so yes you get your calls at times you to wake up that's a part of professional you can say haszard you can but it's there so I try to but uh I try to get that sleep and uh most important we talked about is like focusing on the diet is very very important I don't skip my breakfast I eat whatever is needed lunch is always a working lunch a dinner with family family time and work life balance you make sure whatever is whatever is possible but you prioritize that yes yeah I think so prioritization start at the mental level yeah and obviously there you have a daughter you have a beautiful daugh yeah you have a beautiful daugh so you you spend time with her I try to as much as I can she's getting into her teenage so she tries to be away from me but I try to cling to her nice nice all that helps to decrease AOL things ultimately it's the cortisol Adine Rush the inflammation which plays a role and um I think so this all is is less focused on and um less talked about but uh very important beautiful yeah it's very very important wonderful yeah wonderful so I hope with this discussion at least 1% of the people watching right changes yes that's a success for us that's a success for us yes success for us that's a success for us yes thank you again for such a wonderful interview I'm absolutely flowed and Amazed by the hard work that you do keep doing the good work we need you take care of yourself even more thank you for your time it was a pleasure me here thank you so much thank you I had so much fun in this episode discussing with Dr ano tand I'm sure you learned a lot as well again I don't want you to just move on think about what you learned during the podcast I want you to write down in the comment section so that the writing actually registers the fact in your mind so that you will actually implement it and not just use this as a bystanding video and just a scrolling thing I don't want you to do that okay so I want you to learn at least one or two points and hopefully you'll be implementing that not only to yourself but also to your family members so that together we can grow better both physically and also mentally thank you for your continued support please consider subscrib to my channel gut feeling with Dr pal clips and cut feeling with Dr pal shots two separate Channels with condensed clips from 8 to 10 minutes and sometimes one minute shots and reels of this clip from the longer 1H Hour podcast highlighting the San Futures so if you're a person who wants to listen to the audio format maybe while you're commuting or while you're driving we are available in Spotify as well please check out the link gut feeling with Dr pal and Spotify as well as usual thank you so much for your continued support remember one belly at a time it is absolutely important I'll see you in the next video