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Cardiac Expert Answers Your Queries: Dr. Upendra Kaul

upendra kaul

Prof Upendra Kaul, Executive Director and Dean at Fortis Escorts Heart Institute and Research Center and Fortis Hospital, Vasant Kunj, New Delhi.

Dr. Kaul has answered questions posted by users via comments:

Query 1:Dear Sir, I am 46 years old faced with a minor heart attack one and half year back and was treated by angioplasty. I have been taking the prescribed medicines on a regular basis. But I’ve been facing pains between chest and beginning of stomach area. Is it related to my heart?
Kindly help in eliminating this problem.
Anticipating reply soon.
Thank you.

Dr. Upendra Kaul’s Answer: I think you need an evaluation by your cardiologist. It could be in the form of a routine check and a stress echocardiography or stress thallium/MIBI scan.
Symptom alone cannot be diagnostic.
I do hope you have been taking anti platelets and statins in high dose as must have been prescribed by your treating physician. In addition your BP, blood sugars and lipids should be well controlled . I hope you are not a smoker.

Query 2: My mother had an angioplasty a month ago at Fortis,delhi, because of single vessel disease. Now she is complaining of light pain where the angioplasty was done,and also she has some gas related problems and cough problem, can u please reply why is it happening?

Dr. Upendra Kaul’s Answer:  I think she needs an evaluation by your cardiologist. It could be in the form of a routine check and a stress echocardiography or stress thallium/MIBI scan.Symptom alone cannot be diagnostic.I do hope she has been taking anti platelets and statins in high dose as must have been prescribed by your treating physician. In addition her BP, blood sugars and lipids should be well controlled. I hope she is not a smoker.

Query 3: 
Age – 46yrs old
My weight-75 kg
I walk everyday for about 1hr n 10 min approx 8km. About 1 hour after the walk I drank 20 ml of whisky suddenly darkness appeared in front of my eyes, I felt heavy n then fella and remained unconscious for about 30sec. When I went to the hospital my BP 80/100 n ecg normal. What can be the reason of sudden unconsciousness??

Dr. Upendra Kaul’s Answer:  It could have been a benign event called neuro cardiogenic syncope Which is often precipitated by prolonged upright posture and alcohol which also produces dilatation of blood vessels could have contributed towards it.
It is often a very benign problem and occurs in the life time of a large number of persons. If it has been recurrent then it needs more evaluation by a physician /cardiologist.

Query 4: Want to know about Heart Disease. I had a problem about three years back – a stent was fixed and now I am on medication. Please advise which is best medicine,my age is 70 plus.

Dr. Upendra Kaul’s Answer:  All persons after a stent deployment in coronary arteries need some common drugs even after 1 year. These are Aspirin , atorvastatin/rosuastatin in high doses. Management of predisposing factors like hypertension and diabetes etc  lifelong. In addition regular exercise, eating a heart healthy diet is an essential accompaniment.

Query 5: I am an artist (painter) by profession. On July, 2011 I had suffered malaria twice. In August my left chest started paining, I had done ECG and the Doctor said palpitations problem, he prescribed alparex tablet. In 2012 I have shifted to homeopathy Treatment and in 2013 I left my homeopathy treatment. Recently my problem has started,again, I have been feeling suffocation and left chest pain , please advise me what to do?

Dr. Upendra Kaul’s Answer: This needs consultation with a doctor (Physician / cardiologist) who will investigate the cause by performing suitable tests depending upon your clinical assessment.

Query 6: I am 60 retired as a school teacher. Hypertensive since last 10-15 yrs under medication. Recently after symptom of shortness of breath I was diagnosed after no of related tests and echo dilated LV. EF about 40%.Type2 diabetes also. Under medication for hypertension, diabetes and enlarged heart.Tiredness/pain in leg muscles are the current symptoms.Kindly suggest measures to lead a near to normal life.Probability of deteriorating health ??
Thanks in anticipation of this favor.

Dr. Upendra Kaul’s Answer: Being a diabetic and a hypertensive you are more prone to heart disease especially blockages of heart arteries.This would need full evaluation in the form of a stress echo or a stress thallium study which if indicative of ischemia, calls for a coronary angiography.I am sure your high BP and diabetes is being managed well. The tiredness and pains in legs could be due to peripheral neuropathy. A complication of diabetes. Once again to be managed under medical supervision.

Query 7: I had under gone a bye pass surgery in 1999 at Escorts . I had no serious problem but for a routine check up I went to a private hospital at lucknow. After an ecg, TMT for a short while and eco the cardiologist suggested angiography and prescribed ranozex in place of dilemma which I had been talking since my operation. Another med is angispasn 2.5mg.kindly suggest me the right medicine.I hadn’t gone for angiography.

Dr. Upendra Kaul’s Answer: Since it is around 15 years after bypass surgery and obviously non invasive tests are indicating some problems an angiography to evaluate the grafts and native vessels should be in order. Often the problem can be fixed by angioplasty etc in such situations. You are on anti anginal drugs which can be modified under supervision by your treating doctor.

Query 8: I need help for my brother. He had a myocrardial rupture surgery in Jan 2011 but unfortunately even after surgery he has left to right shunting of 5.2 mm which has now increased to 7.2mm, and i am really worried about it. Would you be able to suggest what should we do now? Is it really risky? is a open heart surgery a good idea please suggest as we are really worried about it. and i will be really grateful for your help.

Dr. Upendra Kaul’s Answer: The question is not clear. The best person would be the doctor who treated him for the shunt or whatever issue he had.

Query 9: Dear Doctor,
I am 63 years old Engineer working at a Project Site as Manager in Middle East. My Blood Pressure particularly in the morning remains below the minimum limit 121/83 mentioned in some reference for my age group .It is around 105 to 120/60 to 70 with pulse rate around 60 to 70 .I am not taking any BP tablets .I feel tired in the morning to do my work .I do Tread Mill walking for 15 minutes .My food intake is under full control .All other parameters on blood test like HDL,LDL are within limit . Please suggest the reason and remedial measure for my problem .

Dr. Upendra Kaul’s Answer: Your parameters seem to be fine by all definitions.Symptoms appear non specific. You should have a general health check up to find out the cause if any .

Query 10: I went through a bye-pass at Medanta, Gurgaon about 3 years back, but still I feel pressure on my heart and this pressure gives me discomfort but does not affect my routine. The duration of the pressure is some time more than 12 hours a day and when it disappears, I feel greatly relieved. The pressure in the morning on waking comes down after clearing the bowels, which is my first action on rising with a glass of hot water to bathe. I. Am not diabetic. I am 68, maintaining good health. My working capacity is tremendous even today. I am pure veg., no smoking, drinking. Any guideline to get rid of this heaviness and it’s cause, so that my mind is clear. Thanks a lot.

Dr. Upendra Kaul’s Answer: I cannot find any specific reason for your symptoms. Best to see your doctor to evaluate you.

Query 11: I am obese suffering from regular chest pain with severity more in left chest since from 2009 and which is increasing day by day. I’m diagnosed with cervicle & lumbar spondylysis, GERD, Lax cardia with peptic esophagitis, acute biliary gastritis, dueodenitis. 2 tmt done during 2009 & 2012 both r negative; 2d echo done in june11, nov 12, Dec 13 & Aug 14 all r shown normal chambers, good LV systolic function , No RWMA & No clots/VEG/PE/PAH with EF ranged from 68 to 70%. Further, during January 2014 xray revealed bronchytis with cardiomegaly. Several ECGs done and 2 Echo’s but all r normal Dr. is saying consult arthopedician. I m much worried on these things pl advice me for further treatment.

Dr. Upendra Kaul’s Answer: The investigations done are all normal as far as cardio vascular system is concerned. A good internist needs to be consulted.

Query 12: Sir .my sgot and sgpt has increased to 48 and 56 due to alcohol consumption in the last month. I am feeling shortness of breath …I am taking supradyn multivitamin tablet on dr.’s prescription. But sir is still breathing problem….which medicine should i take.. And how to cure this problem.

Dr. Upendra Kaul’s Answer:You need to be investigated for your shortness of breath . It would need ECG and echocardiography. And a stress test at least. Liver enzymes are mildly deranged but if you are bothered about them give up alcohol at least.

Query 13: I’m 40 years old got a DES stent implanted in My LAD that was blocked to 80% at Fortis Amritsar 15 months back. I feel chest pain ,tightness in my chest daily. My cardio says it is muscular. I feel pain during exertion but not always. Pain./tightness/comfortable feeling during walking is felt but no shortness of breath. BP?sugar?cholosterol is normal rather very good. Weight 55kg. A good job happy family No stress. Plz guide me regarding my problem
Rajan Kapoor

Dr. Upendra Kaul’s Answer: Anybody who continues to have symptoms suggesting angina needs an evaluation in the form of a stress echo or a thallium scan. If suspicion is high a repeat angiography.

Query 14: 1. I would like to know the relation between the High Blood Pressure and Hyperthyroidism
2. How to manage Hyperthyroidism with respect to diet, would like to know the diet best suited for Hyperthyroidism and precautions to be taken?
3. Advise on Hyperthyroidism and High Blood Pressure

Dr. Upendra Kaul’s Answer: In hyperthyroidism because of a high output state and increased catecholamine secretion to some extent systolic pressures can be high. Beta blocking drugs like Inderal. Metoprolol etc are useful agents to treat. There is no special diet to treat hyperthyroidism but salt restriction is always useful to manage hypertension as an adjunct.

Query 15: Which Doctor to consult for erectile dysfunction at Bangalore. I am a heart patient who had angioplasty three years ago.

Dr. Upendra Kaul’s Answer: Erectile dysfunction has a multi factorial etiology. Since you had an angioplasty it is worthwhile to rule out a vascular cause and having a consultation with a Doppler study to evaluate a vascular deficiency is advocated. If it is normal a urologist may be seen. It could also be drug induced or related to sub conscious anxiety.

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