On 25 May 2024, Seniors Today hosted their weekly Health Live webinar with Dr Chandrasekhar Kulkarni, a Senior Cardiothoracic and vascular surgeon who spoke on and answered questions about Heart Disease given family history and heredity.
About Dr Chandrasekhar Kulkarni
Dr Chandrasekhar Kulkarni is Director & Head – CVTS & Heart and Lung Transplant, Robotic Heart Surgeon at the Nanavati Max Super Speciality Hospital, Mumbai
His train education and training include
- Fellow Cardio Thoracic Surgery, Greenlane Hospital, New Zealand (2006 – 2008)
- M.Ch. CVTS, KEM Hospital and Medical College, Mumbai (2001 – 2004)
- M.S. (General Surgery), Tata Memorial Hospital, Mumbai (1998 – 2001)
- DNB (General Surgery), Royal College of Surgeons of Edinburgh, UK (2001)
- M.B.B.S, LTM Medical College & Hospital, Mumbai (1992 – 1998)
He has years of experience in the field of CTVS, which includes:
- Chief Consultant, Cardiothoracic Surgery, Programme Head – Heart & Lung Transplantation in Minimally Invasive & Robotic Cardiac Surgery, Global Hospitals, Mumbai (2019 – 2024)
- Consultant, Cardiac Surgery, Dr L H Hiranandani Hospital, Mumbai (2019)
- Consultant, Cardiac Surgery, Jehangir Hospital, Pune (2009 – 2017)
He is an accomplished and experienced surgeon with many awards to his name, some of which are:
- Dr P K Sen Gold Medal in CTVS, Mumbai University
- Gold Medal for MS General Surgery, Mumbai University, Gold Medal in Pharmacology, Mumbai University
He is also an esteemed member of many prestigious medical associations- both national and :
- Indian Association of Cardiovascular Thoracic Surgeons (IACTS)
- Membership of The Royal College of Surgeons (MRCS), Edinburgh
His areas of expertise include:
- Endovascular Aneurysm Surgery
- Heart & Lung Transplants
- Adult Cardiac Surgery
- Robotic Assisted Total Arterial off – pump CABG with Bilateral Mammaries
- Minimally Invasive CABG with left anterior Thoracotomy
- Minimally Invasive Valve Replacement through
Thoracotomy – Aortic, Mitral and Double Valve Replacement
- Mitral Valve Repair – Open and Minimally Invasive
- Aneurysm of aorta including Thoracic and Abdominal Surgical and Endovascular Procedures
- Type A Aortic Dissections
- Cardiac Trauma
- Minimally Invasive AD and VSD Repair
- Minimally Invasive LA Mixoma and other Cardiac Tumor Surgery
- Thoracic and Mediastinal Surgery
- Lobectomv. Pneumonectomv. Decortications
- Diagnostic & Therapeutic VATS
- Mediastinoscopy
India has been the capital of heart disease and diabetes since the early 2020s, according to the Lancet Journals- who predicted this in 2008.
It is also seen that our population is prone to suffer from these diseases at an earlier age and a more graver severity in comparison to our other global counterparts.
This is due to our genetic composition and what triggers this is our lifestyle- stress and smoking being the major factors.
It was earlier taught and also observed in practice that women were protected from heart diseases due to the hormones, but it is now being observed that even younger women, occasionally even below the age of 45 are suffering from heart disease, and the increased incidence of women smoking is one of the factors. Earlier, it was uncommon to find women smoking in the urban areas, you would however find women smoking in the real areas. This has now changed with young and a larger number of women smoking in the urban areas too.
Any heart disease can be of any of the following types:
Structural Heart Disease: associated with problems or damage to the valves or the structure of the heart
Functional Heart Disease: the most common and important cause for a functional heart disease is a blockage in the heart. The patient can either present as a case of heart attack/ cardiac arrest or an anginal pain. This defect in the heart function can either be:
Mechanical: this can include a significant and rapid onset of block in one of the major arteries of the heart where there is a critical reduction in the blood supply within a fraction of a second. This itself can result in a significant reduction in the blood supply. In such a case, the heart itself does not get adequate blood to perform its functions. This leads to a vicious cycle of inadequate blood supply to the heart resulting in inadequate contractions, ultimately resulting in a cardiac arrest.
Electrical: this can be due to some electrical abnormality in the heart which can lead to an abrupt increase in your heart rate. In this case, your blood circulation is hampered. Your heart is not able to contract well and completely thereby leading to insufficient rise in the blood pressure, and decreased flow of the blood to organs including the brain which will result in the patient passing out. This is the most common reason for a cardiac arrest.
Patients with a classical attack presents with sudden onset chest pain with uneasiness, on ECG and blood investigations a diagnosis for a heart attack is made. If the heart attack is a significant one, the patient may even suffer from a cardiac arrest.
The difference between a heart attack and a cardiac arrest lies in the state of consciousness of the patient. In case of a heart attack, the consciousness of the patient is intact, thus he is awake and can talk and tell you about his complaints. Whereas in case of a cardiac arrest, the patient is unresponsive.
Anginal pain is very common in people who are non diabetic. In patients who are diabetic, it is often seen that they present with typically a pain in the chest.
In anginal pain, chest pain and breathlessness are considered equivalent. This is a more chronic problem, but the upside to it is that it gives you more time to respond adequately and understand the problem and lead to a proper and timely diagnosis.
People who have a gradual increase in the size of the plaque/ blockage present with anginal pain.
All of the above issues arise due to a problem in the circulation.
The heart is an interestingly unique organ where it does not receive blood supply throughout the time of a beat.
Every heartbeat comprises of 2 phases:
Contraction: the pumping chambers of the heart ie the ventricles push the blood out of the system during the time or contraction, the arrangement of the heart is in such a way that the blood vessels and the muscle fibres are arranged in right angles to each other. The blood vessels are naturally weaker than the muscle fibres, therefore, during a contraction, it presses on the blood vessels because of which there is no flow of blood to the muscle of the heart during the contraction.
Relaxation: required to fulfill the oxygen and blood demand of the cardiac muscle and to also prepare for the next cycle of contraction.
This is why having clear arteries is very important. But as we age, our arteries get blocked, and this begins in the second decade of our lives. Gradual increase in the reduction in the blood supply happens because of gradual blood up in the blockage. This is a circumferential problem leading to decrease in the diameter/ cross sectional area of the artery for effective blood flow.
This block usually starts as a small blockage in the internal surface of the heart vessel- this can be due to small stress factors that cause damage to the blood vessels. These include- cholesterol, raised blood sugar, high blood pressure, etc. there can also be deposition of calcium in the later stages of blockage.
Early blockages are called soft plaques also known as unstable plaque. They are made up of cholesterol, sugar, platelets and dead blood cells. Thus, if there is a sudden rise in the blood pressure, either due to stress or anxiety, it can lead to sudden increase in the clogging of the arteries. And this is what is called an Acute Heart Attack.
Clarification of the blood vessel is an indicator of a long standing disease.
Risk factors for cardiac disease :
- Genetic predisposition
- Family history of hypertension, diabetes
- Stress
- Smoking
- Inadequate physical activity
Stress is the main risk factor which is in today’s time giving rise to cardiac disease even in the young.
Metabolic syndrome is nowadays common in the Indian population. This includes:
- Simple obesity
- Hypertension
- Diabetes mellitus type II
- High triglycerides
- These individuals also have Less amount of good cholesterol which is HDL
