On 20 May 2023, Seniors Today hosted their weekly Health Live Webinar with Dr Vishal Khullar, a Senior Cardiothoracic Surgeon, who spoke on and answered questions about Hypertension and Heart Health.
About Dr Vishal Khullar
Dr Vishal Khullar is Director of Cardiothoracic Surgery, Heart & Lung Transplants at the Nanavati Max Super Speciality Hospital, Mumbai. After completion of his super-specialisation in cardiac surgery in India, Dr Khullar honed his skills at world’s topmost medical institutions Cleveland Clinic Foundation, Cleveland and Mayo Clinic, Rochester in the United States.
Dr Khullar has performed and participated in over 7000 successful general cardiac procedures including bypass surgeries, valve replacement, complex surgeries of the aorta (including Aortic Root Replacement, Ascending Aortic Replacement and Aortic Arch Reconstruction) and Heart and Lung Transplants at these prestigious institutions.
Experience:
- Dr Vishal Khullar, Director of Cardiothoracic Surgery, Heart & Lung Transplants, Nanavati Max Super Speciality Hospital, Mumbai.
- Senior Registrar, Cardiovascular and Thoracic Surgery, BYL Nair Hospital & TN Medical College, Mumbai (2010-2011)
- Junior Consultant, Adult Cardiac Surgery, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai (2011)
- Associate Consultant, Cardiac Surgery, P. D. Hinduja Hospital & Medical Research Center, Mumbai (2012)
- Consultant, Adult Cardiac Surgery, Bombay Hospital & Medical Research Centre, Mumbai, (2013-2014)
- Assistant Professor of Surgery, Mayo Clinic School of Medicine & Senior Associate Consultant, Department of Cardiovascular Surgery, Mayo Clinic, Rochester, USA (2018-2022)
Education & Training:
- MBBS, B. J. Medical College, University of Pune (1997)
- MS, General Surgery, KEM Hospital & Seth G S Medical College,Mumbai (2002-2005)
- Senior Resident, Surgical Gastroenterology and Liver Transplant, Sir Ganga Ram Hospital, New Delhi (2005)
- Senior Resident, General Surgery, Fortis Jessaram Hospital, New Delhi (2006-2007)
- MCh, Cardiovascular & Thoracic Surgery, Bombay Hospital & Medical Research Center, Mumbai (2007-2010)
- Clinical Fellow Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, USA (2014-2015)
- Clinical Fellow Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, USA (2015-2016)
- Clinical Fellow Advanced Aortic Surgery, Cleveland Clinic Foundation, Cleveland, USA (2016-2017)
- Clinical Fellow Heart & Lung Transplant and MechanicalCirculatory Support, Cleveland Clinic Foundation, Cleveland, USA (2017-2018)
- ECFMG certification (Educational Commission for Foreign Medical Graduates), USA
- United States Medical Licensing Examination (USMLE) Step 1, Step 2 CK, Step 2 CS and Step 3, USA
- Unrestricted Medical Licence, Minnesota Board of Medical Practice, Minnesota, USA
- Unrestricted Medical Licence, Medical Council of India
- Unrestricted Medical Licence, Maharashtra Medical Council, Maharashtra, India
- Unrestricted Medical Licence, Punjab Medical Council, Punjab, India
Basics about the function of the heart:
The heart has 4 chambers. The upper two chambers are called the right and left atrium. The lower chambers are called the left and right ventricles.
The atriums are very receptive, distensible. Their basic role is to receive the blood. The right side of the heart receives the venous, deoxygenated blood from the lower and upper half of the body. Thus, the deoxygenated blood comes to the right atrium and then goes into the right ventricle.
The lower two chambers, the ventricles are muscular. Thus, the right ventricle after receiving blood from the right atrium pumps the blood through the pulmonary artery into the lungs. And as we breathe, the blood is oxygenated and is returned back to the heart through the pulmonary veins into the left atrium, from the left atrium the oxygenated blood goes into the left ventricle which pumps the blood to the rest of the body.
The heart has 4 valves. The one on the right is the Tricuspid Valve- blood goes from the right atrium to the right ventricle through the tricuspid valve.
When the blood goes through the heart to the lungs via the pulmonary artery, another valve is in place, called the Pulmonary Valve.
When the blood comes from the lungs to the left atrium, and then into the left ventricle, the valve between the left atrium and ventricle is called the Mitral Valve.
The left ventricle pumps the blood into the body through a large vessel- Aorta, through the Aortic Valve.
Coronary arteries are the vessels that supply the heart. These are the first branches of the aorta and carry oxygenated blood.
Some of the common heart diseases are :-
- Valve stenosis and regurgitation: Mitral and aortic valves are the most commonly affected valves, leading to heart diseases. They can be affected by Rheumatic Heart Diseases. As the age advances, the valves can also degenerate.
If the aortic valve starts leaking, over a period of time, the left ventricle dilates and can lead to heart failure.
- Thoracic aortic aneurysm: The large vessel that arises from the heart and circulate blood to the rest of the body- aorta, this vessel too can become aneurysmal, it can dilate over a period of time and sometimes it can even rupture or dissect.
- Coronary Artery Disease (CAD): the blood vessels that supply blood to the heart can have fatty deposits in them, which can lead to blockage in the blood vessels of the heart. For this, an angioplasty and by-pass surgery is a common intervention.
- Cardiac Arrhythmias: The automaticity of the heart can become disrupted because of the disorganisation of the electrical signals that help in pumping the blood and the beating of the heart. These are called Cardiac Arrhythmias- irregular heart beats. Some of the common examples are Atrial Fibrillation, Atrial Flutter, etc.
- Hypertrophic Obstructive Cardiomyopathy (HOCM): Thickening of the muscle of the heart- myocardium. This can result in heart failure and sudden death. This is called Hypertrophic Obstructive Cardiomyopathy (HOCM). It is a common cause for sudden death. One of the common causes for sudden death in young adults, especially athletes.
- Pericarditis: Pericardium is the layer of the heart around the heart. There are certain conditions wherein the pericardium can become infected and cause pericarditis. The pericardium can also become very thick and lead to cardiac failure. The most common cause of pericarditis in our country is pericarditis.
- Heart failure- the ventricles, the muscular chambers of the heart, due to disease of the heart can dilate and fail to function properly over time. This can be treated medically followed by surgical intervention.
Difference between heart attack and cardiac arrest:
Cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly. There is no beating of the heart, there is a complete and total arrest of the function of the heart. Complete cessation of the electrical activity leads to cardiac arrest.
Heart attack occurs when the blood flow/ supply to the heart is either partially obstructed or competently blocked. This is typically seen in patients with Coronary Artery Disease.
Cardiac arrest can happen due to a heart attack.
Heart failure can occur due to multiple reasons- dilated ventricles, electrical dysfunctions, patients with HOCMs, valvular heart disease- when left untreated, severe aortic and mitral stenosis.
Causes of heart failure:
- Genetic
- Male gender are a a higher risk of CAD than female counterparts
- Lifestyle
- Diet
- Exercise/ inactivity
- Control over comorbidities such as high blood pressure, diabetes
- Smoking
- CAD
Symptoms of heart failure:
- Dizziness
- Tiredness/ fatigue
- Shortness of breath
- Palpitation- conscious awareness of your heartbeat
- Fainting spells
Ways to prevent heart disease:
- quit smoking
- Regular monitoring of blood pressure
- Compliance with anti-hypertensive medication, if on any
- Regular monitoring your cholesterol levels. LDL less than 70mg/dL- if you have a family history of heart disease/ a past history of the same
- Regular exercise
- Eat better, eat healthy. Avoid saturated fatty acids, foods rich in cholesterol
- Good control over blood sugar levels
- Reduce your salt intake
- Include more fruits and vegetables
Treatment of heart failure:
- Pharmacological
- Surgical: angioplasty/ by- pass surgery for patients with blockage in the arteries. Dilated valves- valve repair/ replacement
- Artificial pumps- Left Ventricular Assist Devices
- Heart transplants
Disease of the heart can also affect the lungs.
