Cardiac Expert Answers Your Queries: Dr. T.S Mahant

Dr. T.S Mahant: Executive Director, Cardio Thoracic & Vascular Surgery

1). Query by Rajiv Shankar (Age – 36): Respected sir, I am getting chest discomfort and pain which I feel sometimes radiates to my hand. I have no neck pain. I am not diabetic or hypertensive. I did my TMT 6 months back which was negative. I also did my CT coronary angio 3 months back which is normal. What should my further course of action be to rule out any disease?
Other Relevant Info: I am an asthmatic.

Dr. Mahant’s Answer: CT angiography is good for screening of Coronary Artery Disease. Looking at Your age and no risk factors, it is very likely that you may have cardiac problems as the CT angiography is normal. But regular coronary angiography is gold standard for diagnosing coronary artery disease; but it is not indicated in your case.

2). Query by Karuna Karan (Age – 43):  I Am A Diabetic And Have High Blood Pressure(Max 160/100) For The Past Two Years Now. I’m 43 Years Old.Having Glycomet 500mg Only In The Morning Before Food And For Bp, Taking   Eritel Ln40,P  Razophil Xl5mg And Revelol H 50 Each 1 In The Morning And Night After Food, Taken Ecc,Echo And Tmt Last Month (16/08/2014).  My Blood Sugar Level 84 Mgs/Dl(F), 150mgs/Dl(Pp)  And Ldl &Hdl  Are Within Limitis. I Feel Tired And Feel Sleepy .While Going For My Job I Feel Tired And Breathing Is Uneasy. Kindly Advise Me What Kind Of Medication I Need To Have To Control My High Bp And My Breathing Uneasiness.

Dr. Mahant’s Answer: Your BP, Sugar levels and lipids are in control. I would like to ask- are you overweight? do you snore loudly while sleeping? If yes, then you need to consult a pulmonologist for screening of Obstructive Sleep Apnea (OSA) because of OSA you might feel sleepy during the day.

3). Query by Deepak Naganna (Age – 45): I’ve been diagnosed with irregular heart beats since 2000. However, my doctor indicated I needn’t worry about this and had prescribed Ziram 2.5 mg tablets to treat my high BP since 2010. However, since the past couple of days, my BP has gone up to 140/110 and my doctor increased the dosage to Ziram 5 mg and also asked me to get an echo since he suspected auscultatory gap while checking my BP. Please let me know your opinion whether I need to get an echo done since I have a past history of irregular heart beats. Please let me know what I need to do to bring my BP under control.

Dr. Mahant’s Answer: You need to control your BP with weight reduction, exercise, life style modification and medication. You need to consult a cardiologist regarding irregular heart beat and if required, EP Study. You can get 2D- echocardiography done which is harmless, non invasive test (U/S of the heart).

4). Query by Shopana Viswanathan (Age – 51): I had 2 minutes of mild chest tightening as soon as I got up in the morning and again in the night accompanied by severe pain in both the arms for about 15 minutes.My breathing was normal and there were no other symptoms.The pain went away after taking a voveran tablet and rubbing volitra cream.When I had depression in 2012,I had the same arm pain and numbness which went away with neuro gardian tablets.There was no discomfort of the heart then. I would also like to mention that I have wrong habbit of sleeping with my arms folded under my head. I am not a diabetic but my triglycerides is around 460 mg/dl and thyroid is 3.22ng/dl. So far I was a hypothyroid. My cardiologist has advised me to do angiogram.I want to know if it is necessary?
Other Relevant Info: Has occipital neuralgia.

Dr. Mahant’s Answer: Yes, you need to have angiography done in view of your symptoms and risk factors like diabetes and high cholesterol. It will clearly indicate whether there is any blockage or not. If not, we can look for other causes of your pain.

5). Query by Md Wasi Akram (Age – 56): My mother, 56 yrs of age is suffering from dilated cardiomyopathy since a long time and day by day her condition is deteriorating . Presently Doctor suggested for an operation. I need to know what should be done now to go for surgery or for other treatment. I am enclosing few details of her report.
Other Relevant Info: Reports: Dilated cardiomyopathy, Severe MR, Severe TR, severe PAH  Severe LV systolic dysfunction with grade I diastolic dysfunction.

Dr. Mahant’s Answer: Your mother needs to consult a cardiologist and get a angiography done. If angiography is normal, she needs to be on medical management as she is a case of very high risk surgery.

6). Query by N Kr (Age – 32): I am 32, my total cholesterol is 213, hdl is 41 and triglyceride is 150. I have started exercise and lost some 3-4 kg weight. I was 69 kg earlier and now I am 65,my height is 172 cm, (5’8″). Sir should I start taking medication also.. If yes then for how long and which statin I should take.

Dr. Mahant’s Answer: For your high cholesterol, at first you should try diet control, high fiber diet, daily exercise and if you have other risk factors such as diabetes, hypertension, smoking, strong family history, you need to consult a cardiologist and if indicated, medication/ statin may be started under medical supervision.

7). Query by Manas Nandi: For a cardiac patient of 82yrs age with partly blockage of valve who is on medication for the last 20 years and maintains regular exercise(and walking) along with controlled diet, is it alright to eat Dates, Almonds, Walnuts?

Dr. Mahant’s Answer: Almonds and walnuts are beneficial for the heart, if taken in small quantity every day. Dates are not contraindicative if you are not a diabetic.

8). Query by G Raghuram (Age – 54):  Can a person having BP and under medication donate BLOOD or not?

Dr. Mahant’s Answer: If your Systolic BP is < 180 and diastolic < 100 and on BP medication, you can donate blood.

9). Query by Priya Doshi (Age – 50): I am 50 years old [weight 64kg;Height 160cm] with my lipoprotein [a] levels perpetually high in the range of 45-50 units.[normal upper limit 30]. Recently my report came as 70 units inspite of being on Rosuvastatin 10mg and Ezetemibe combination for three months. I have also tried Rosuvastatin upto 20mg/day in the recent past again without helping to lower this level below 50 units. I know it is a very bad cholesterol. Can you guide me if there is an effective medicine and dose to help lower the level. Please suggest if there is any natural remedy?
Other Relevant Info: Hypertensive since 4 years On S-Numlo 2.5 mg/day

Dr. Mahant’s Answer: To reduce lipoprotein (A), there is no FDA approved drug but niacin has been seen to reduce Lipoprotein (a) levels. You need to consult a cardiologist and endocrinologist for medication to lower your lipoprotein (a) levels as it is a high risk indicator of cardiac disease. Lipoprotein (a) levels are not affected by diet, exercise, weight loss and statins.

10). Query by Shubh gupta (Age – 29): My heart pounds when I lie down, sit taking aid of something and when I sleep making me very uncomfortable and giving me sleepless nights.The problem started 2 months back, I have undergone several tests which showed high ldl, cholesterol and vitamin D deficiency. I have also undergone Holster test which was normal(no pounding that particular day), ecg (normal as there is no pounding during the ECG).The problem stopped for few days after I started some medication by general medicine doctor (medication to control cholesterol and lumia 60k for vitamin D dediciency-20 days medication) but now again the problem has started. I also feel some sounds like movement of cartilage near the heart area  when I move my left hand (when I have heart pounding). I am 28 years of age and my weight is 73 kg, 5 foot 9 inch tall with BMI of 23.6.I have been jogging for 3 weeks now,I feel good after jogging as the pounding stops for 4-5 hours after jogging. Please help.
Other Relevant Info: Back neck pain,headache

Dr. Mahant’s Answer: You need to get a ECG during the episode of heart pounding and you need to consult a cardiologist/EP Expert.

11). Query by Aditya Kumar (Age – 25): I am a 25 year old student. I have a problem of short breathing and feel weakness on just walking few foot steps. My heart beats so hard that I can feel it 24 hours. Sometimes in the night the heart beat is so fast and hard that I can’t sleep, I had depression for the last 7-8 years , the doctor examined my ecg and told me that my heart is enlarge from normal. Now they told me 2deco cardiogram. I am waithing for it … if you please describe then it so helpful for me and others.

Dr. Mahant’s Answer: You need to have a detailed Echocardiography examination done and consult with a cardiologist for further management of heart problems.

12). Query by Rajan Malvankar (Age – 35): My father is 68 yrs old. He has 3 blockages upto 80%. He also has kidney problem. The Doctor says there are problems for angioplasty and bypass for him due to age and kidney problem. I want to know that is there a reliable treatment available?
Other Relevant Info: He is also diabetics and blood pressure and asthma.

Dr. Mahant’s Answer: CABG can be performed in patients with Kidney problems/diabetes with reasonable risk. Your father is 68 years old with 3 blockages with kidney problem, he should undergo CABG.

13). Query by Sanjay Sharma(Age – 40): Namaskaar Dr. mahant,  सर मैं इंग्लिश नहीं जानता इसलिए आप से हिंदी में ही क्वेश्चन कर रहा हूँ।  वर्ष 2005  में मैं किसी बड़ी पारिवारिक क्षति के कारण डिप्रेसन में चला गया और तभी से मैं नियमित रूप से Escitalopram-10mg+ Propranolol HCL की एक -एक गोली रोजाना ले रहा हूँ।  हालाँकि अभी तक मुझे इन से कोई परेशानी नहीं हुई है ( हाँ मोटापा जरूर बढ़ा है ). मैंने कहीं पढ़ा है कि  इन् दवाओं के नियमित सेवन से ह्रदय रोग होने की संभावना बढ़ जाती है। मेरी लाइफ काफी व्यस्त है और मैं कसरत के लिए समय नहीं निकाल पा रहा हूँ। मैं इन् दवाओं से भी छुटकारा पाना चाहता हूँ क्या मैं इन् दवाओं से छुटकारा प्राप्त कर सकता हु।  क्या मुझे भविष्य में कभी इन दवाओं की वजह से ह्रदय रोग हो सकता है।  कृपया मेरी शंकाओं का समाधान करें।

Dr. Mahant’s Answer:

14). Query by Giriwar Karnani(Age – 58): My Mother Saroj Devi karnani age 58 years recently reported a chest pain and was admitted to B M Birla Heart Research Center in Kolkata. Angiography was carried for my mother. The report revealed lesion in the following arteries.  LAD:It shows 80%lesion at the origin of SP1.The LAD after D1 again shows 70%lesion. The distal LAD is normal. LCX: Non Dominant. The OM1 shows 95% lesion. RCA: Dominant with early bifurcation and shows 80% lesion before bifurcation. The PDA is normal and PLB shows proximal 70-80% lesion .The PLB also gives PDA like branches. Triple vessel coronary artery disease with mild systolic dysfunction.We have two questions-
1)The chest occurred on 24-09-2014 and angiography was done  on 25-09-2014.Consultant doctor suggested for By pass surgery .Our question is whether we can wait for one month and then go for surgery or at the earliest we should go for the surgery . Please advise when should we go for surgery.
2) Is robotic surgery is feasible in the above discussed case. Please advise
Other Relevant Info: Patient has gastric problem on the higher side. Earlier has been operated thrice .Two operations for pregnancy and third one  was for removing uterus done in 2005. Met with accident 14 years ago. Suffered multiple injuries in leg ,head and left hand partially working 50% due to injury in shoulder  in the accident.

Dr. Mahant’s Answer: CABG is required in your mother’s case. Earlier the better as we cannot predict when she will have heart attack or problem. Elective surgery has low risk as compared to emergency surgery when there is a problem.

15). Query by Vineet Singh(Age – 31): I feel mild pain in the chest around the heart since the last 2-3 months. Generally it stops after drinking lots of water or after 2-3 belch. I am suffering from acidity problem also from sometime, so I thought it might be the problem of heartburn due to acidity. But I am not sure what it is. Before that I was feeling pain for sometime in my left hand above elbow during stress or sudden tension from last 6-7 months, now this thing happens rarely. Is this a normal thing? Please suggest any tests if required.

Dr. Mahant’s Answer: I would like to know- are there any risk factors like smoking, diabetes, hypertension, high cholesterol, family history of heart disease. Does this pain occur on exertion? If no, in absence of any risk factors and your age, you need to consult a gastroenterologist for your symptoms. But if, you have risk factors, then you need to get a cardiology consult also.

16). Query by Santosh Chandola(Age – 74): I am 74 and diabetic. I have blockage in rca and lca. My doctor recommends for cabg. Is it safe in this age and is there any alternate safe treatment for this. I also have gall bladder stone. Could i operate my stone in this condition?
Other Relevant Info: Diabetes

Dr. Mahant’s Answer: CABG is safe at your age. Gall stone Surgery can be performed only after heart has been taken care of.

17). Query by Praveen Kumar(Age – 44): I have pain in the left side of chest and in left arm and shoulder since long. I had angiography in July 2013 in fortis chandigarh and report was normal(normal coronaries).  I had ecg in January 2014 and August 2014 and reports were normal. My lipid profile is normal. I smoke two ,three cigarettes in a day. I do half hour brisk walking and half hour hour running every morning. I am still having pain. I have done three tmt before angiography and were normal. Can this be a cardiac problem. What should I do?

Dr. Mahant’s Answer: Stop smoking. Maintain your exercise routine. Keep your lipids in range. Since you had a TMT and angiography, which are normal, it is not a case of cardiac problem.

18). Query by Praveen Godbole(Age – 58): I am a 58 years old male, vegetarian and non-alcoholic. I have been diabetic for the past 8 years and hypertensive for 10 years. Three years ago, I underwent CABG procedure involving 5 grafts (SEQ LIMA -> DG1 ->DG2 -> LAD (in situ) , SEQ LRA -> OM1 -> OM3 (on Aorta Over SV Patch). I have been on recommended medication since then and have been periodically going to same hospital for follow up visit. So far all parameters are good. About a year back, I developed a condition where I used to go short of breath upon making small effort e.g. climbing two flight of stairs or brisk walk of even 100 meters, especially with small weight (7-8 Kgs). I had consulted the doctor. After undergoing stress echo, I was diagnosed as having developed condition known as ‘Diastolic dysfunction’ in early stages. My questions are:
1. Could this condition be a result of CAPG procedure that I underwent 3 years ago?
2. What is the risk associated with this condition? Is this condition life threatening?
Other Relevant Info: I am both diabetic and hypertensive. I am on regular medication and these conditions are under control.

Dr. Mahant’s Answer:  (a) The condition is because of your disease process and it is not related to CABG performed. (b) It is an early stage of dysfunction and it is not life threatening. You have to be under a cardiologist follow-up.

19). Query by Yashpal Gogia(Age – 49): What is the difference between Angiography and CT angiography. Which method gives better results?

Dr. Mahant’s Answer: During CT angiography,  the dye is given in peripheral vein and CT images are taken. Later 3 – dimensional are reconstituted to see any blockage in the coronary Artery. Whereas during angiography ( Coronary angiography), the dye is directly injected by a special catheter from the groin/radial artery into the coronary arteries and cine images are taken. Regular angiography is the gold standard for coronary artery disease.