My sweet number is 130/80

different cuff sizes bp apparatus

You can have high blood pressure (hypertension) for years without any symptoms (95% of times)

Trust me, it is completely asymptomatic!!

Even without symptoms, high blood pressure   damages blood vessel, heart, Brain&Kidney, continuously.

Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack, stroke& kidney failure.Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. Blood pressure generally should be checked in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff (cuff size is important and same sized cuff  for obese and thin people is not acceptable)Your doctor will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease .

Some important things you must know as a patient, as follows

1. Do not go by one reading!

2.Go to clinic, relax for some time then ask the nurse to measure BP.

3.If you have just smoked or taken tea or coffee it will erroneously show high reading.

Normal BP is 140/90 but my sweet number is 130/80

Without drugs can you reduce BP?

Of course yes!  Possible!

Every 10 kg weight reduction reduces 5 mm of mercury to 20 mm systolic BP (Systolic means upper reading and diastolic means lower reading)

Limiting alcohol intake to no more than 1 oz (30 ml) of ethanol per day for men or 0.5 oz (15 ml) of ethanol per day for   lighter weight people reduces 2 to 4 mm

Reducing salt  intake less than 6 g per day brings down 2 to 8 mm of systolic BP. dietary potassium (take fruits and vegetables) also reduces BP ( we Indians take 20 mg of salt  on an average ….otherwise food is not delicious …..

Maintain adequate intake of dietary calcium and magnesium for general health

Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health

Engage in aerobic exercise at least 30 minutes daily for most days (range of approximate reduction, 4-9 mm Hg) (trust me …it works)

During sleep, healthy people tend to have slight reduction in blood pressure called (“Dipping”). All of us should experience night time dipping because it relieves the blood pressure load during sleep. Many people, either because of poor sleep quality, medications they are taking, or the presence of such illnesses as advanced kidney disease, have “non dipping” (which means paradoxically shoots up high BP) at night, and that increases the blood pressure load and enhances stroke risk and risk for Heart attacks.

The highest risk for heart attack and Stroke occurs in the morning between 6:00 AM and 10:00 AM. This has been known for almost 30 years. You have a greater likelihood of reducing pressure at that time and converting to dipping status. (Selection of drugs and timing of ingestion).You may ask your doctor about this.

Unfortunately, people with advanced kidney disease—don’t seem to be as consistently able as people with normal kidney function to convert from none dipping to dipping.

Remember Dipping is good. None Dipping is bad.

So remember!

Check your BP periodically. (Also properly)

Control it.

Avoid early morning shooting up of high BP.(Monday early morning is very crucial, after week ends)

Next blog I will talk about 24 hour ambulatory monitoring and central aortic pressure ….wait till my next blog!

Avoid open chest operation for valve disease

When open chest surgery the was only solution for heart attacks, simple angioplasty has replaced it in at least 60% of the cases in in the last 15 to 20 years. .But unfortunately until now no solution was available for valve diseases recently. The common valve problem that we see today is mitral valve and aortic valve. Aortic valve is the major valve which paves way for the pumped blood from the heart to entire body. Aortic valve constriction and stenosis (narrowing) causes dizziness, breathing difficulty. Faints and in extreme cases sudden death (because blood does not reach entire body).But now we have got a good technology just as angioplasty, aortic stenosis can be treated by stent without opening the chest ,but not in all cases.

This minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. The surgery may be called a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI).

Valve-within-valve — How does it work?

Somewhat similar to a stent placed in an artery, the TAVR approach delivers a fully collapsible replacement valve to the valve site through a catheter.

Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating

How is TAVR or TAVI different from the standard valve replacement?

This procedure is fairly new and is FDA approved for people with symptomatic aortic stenosis who are considered an intermediate or high risk patient for standard valve replacement surgery. The differences in the two procedures are significant.

Avoid open chest operation for valve disease 1

What is involved in a TAVR procedure?

Usually valve replacement requires an open heart procedure with a “sternotomy.”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place.

A TAVR procedure is not without risks, but it provides beneficial treatment options to people who may not have been candidates for them a few years ago while also providing the added bonus of a faster recovery in most cases. A patient’s experience with a TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and will likely require a shorter hospital stay (average 3-5 days).

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

  • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest
    or
  • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

Who is a good candidate for this type of valve surgery?

At this time the procedure is reserved for those people for whom an open heart procedure poses intermediate risk. For that reason, most people who have this procedure are in their 70s or 80 and often have other medical conditions that make them a better candidate for this type of surgery.with the promising results now researchers are doing this for LOW RISK patients also.

TAVR can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.In coming years this will play a major role and big boon to the patients.

Avoid open chest operation for valve disease2

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A heart attack occurs when a sudden blockage from a blood clot cuts off the food and oxygen supply to the heart muscle. The Golden Hour is a critical time because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged. Heart is a pump. Like bullet shaped. Once the muscle is damaged bullet shape is not maintained and it can’t pump effectively.
So, the faster normal blood flow is re-established, the lesser would be the damage to the heart. 

Why Within golden hour?

The golden hour is a window of opportunity that impacts patient’s life and death. Or quality of life thereafter.

What is our role in the Golden Hour for a heart attack patient? 

To reduce the damage to the heart, it is important to get to the hospital as soon as possible. (Our patients usually go to clinic, and wait to see doctor and waste lot of time. It is important that they should rush to hospital with cath lab facility if possible) Other than the consequences of a damaged heart muscle, the most common killer in the early period following a heart attack is an abnormal heart rhythm called ventricular tachycardia and ventricular fibrillation where the heart muscles contract at a rapid rate (200 to 400)., but no effective pumping of blood from the heart takes place. 

This is why we must ensure that once the person reaches a medical facility (ambulance or hospital); they are immediately put on an ECG monitor to assess the heart rhythm, so they can be given prompt treatment in case of an abnormal rhythm. 

What is the immediate treatment one can expect in a hospital? 

Once the patient reaches the hospital, the primary goal of treatment would be to dissolve the obstructing clot, and restore blood supply to the affected part of the heart. 

This is done, most commonly, by clot busting drugs. But of late, the preferred modality is mechanical dissolution of the clot by a procedure called as primary angioplasty.