heart care in winter months

incidence of heart attack increases during winter months.
cold weather causes the blood vessels to constrict in response to cold there by aggravating the incidence of heart attack in the society.

care should be taken during cold weather to protect ones heart

1.layered clothing should be worn rather than single coat over body. the layers hold the heat in between and keep the person warm 


2.avoid unaccustomed strenuous activity during winter months.

unaccustomed activity coupled with cold weather increases the demand on heart causing it to work more.

3.take frequent breaks in activity.increase the number of breaks to sip in fluid or stretch out .winter months we feel less thirsty and over a period of time we could cause dehydration.

4 .avoid alcohol.alcohol gives a false hope of  warmth


5. winter days are shorter ,there by reducing the amount of sunlight we get in a day . additional vit d supplements and food need to be taken to increase the dietary intake of vit d

mitral valve regurgitation

one or more leaflets of the mitral valve may get elongated and become floppy.the chordae tendonae which are holding the mitral valve leaflets may get torn in the disease process and causing severe mitral regurgitaion.


such patients usually present with pulmonary edema and are breathless on rest.
repair of such dysfunctional valve may be carried out.

rheumatic heart disease

rheumatic heart disease starts in early childhood to make its presence felt in younger days. a lot of work days are lost ,some even remain uneducated because of frequent illness associated with rheumatic heart disease.
the disease process takes form of frequent sore throat infections followed by swelling of joints and limbs.if untreated the disease matures into a fulminant heart disease . it usually affects the mitral valve. in some cases the aortic valve is affected too.

the mitral valve disease is in form of mitral stenosis .in early stages the valve leaflets are not involved in the disease process.


the disease is restricted to the commissures only insuch a situation the mitral commissurotomy can be carried out.balloon mitral commissurotomy is the minimally invasive procedure carried out in the cath lab through femoral vein route.

at times the mitral valve leaflets are not pliable and during the process the mitral valve my get ruptured inadvertantly.then the open mitral valvotomy should be carried out in emergency .if not intervened in time the condition of patient deteriorates quickly.

the other valve affected in this disease process is the aortic valve too.

at times in chronic conditions the tricuspid valve is also involved though it is most of the time functional involvement and not physical .necessating the tricuspid valve repair in form of annuloplasty.

fever

fever is a common occurrence after the patient is operated for heart. patients are given anti pyretic tablets for the same. if the temperature lasts for more than 2 days ,the patients needs to be concerned and visit his operating surgeon for opinion. the surgeon can then change the anti biotics or prescribe new medications.usually we will wait for culture sensitivity report of the blood  and start the required anti biotics.
for fever lasting more than 5 days or sudden spurts of fever not responding to treatment,care needs to be taken to evaluate the cause of fever.there might be an element of infective endocarditis.

mobilization

mobility is an issue post cardiac surgery. after the chest drains are out and patients is free of any inotropics injections ,patients are encouraged to move sligthly. initially in bed then afterwards around the bed and then in the vicinity. patients are requested to take help from relative.

patients should try to walk with hands crossed behind back.if any patients have click of sternum

while getting up from the bed patient is trained to roll over on one side and with help of opposite hand push to get up from the bed .

patient can also take help of a large pillow to lean over the pillow on his side .

lot of walking not only improves the circulation in the body but also build lot of confidence after va major surgery .

patients are taught to take care while walking on stairs too.
this rehabilitation process will take around a months time to adjust to new ways of living . 

post operative rehabilitation post cardiac surgery

post cardiac surgery rehabilitation is a poorly addressed phenomenon in India .

patients will have dry cough. coughing will make the patient chest pain.also few patients will notice rise in temperature. this has to brought to the notice of doctor.

initial few days post surgery are very important for the patient. some patients will notice wet dressing. 

because of change in lifestyle, the body is not able to maintain the liking for food stuff and will complain of nausea every now and then. patients will be prescribed anti emetic tablets.
some patients will have serous discharge from the wound also .click of sternum needs to be taken seriously . i recommend walking with hands folded behind. gradual increasing activity at around home initially then society and when he is confident leaving city limits is encouraged. 

 cessation of smoking is paramount importance.control of blood pressure needs to be reined in. so also diabetes , sugar control. 

getting onto new life patients are anxious of having another heart attack . reassurance and medical evaluation will help. 

resuming sexual activity and physical tolerance excercises need to be addressed. 

keeping the mind occupied in some activity is very important. driving 4 wheeler is fine after recommended one month from surgery . but two wheeler driving is to be judiciously handled. 

meditation and pranayam will help in soothing the nerves. every effort is made to include the patient in the circle of society. loneliness itself is shown to be precursor of heart disease too. so want to get happy , spend atleast an hour in the circle of friends. 

diet is often overlooked and balanced diet is missing in most cases . add to it the patient might have his own calorie deficient  diet and cause loss of muscle mass which is important for generalised well being . nuitritionist can help them re balance their diet . 

weight  loss can be accompanied with severe loss of muscles which is important for generalised well being . young patients tent to exercise more and in view of low protein diet can land up in problem. so quantified nuitrition and strength training exercises are important . 

regular visits to physician and evaluation of physical well being is equally important . 

blood sugars and diabetic

diabetic heart patients are tricky to treat. the stress because of operation causes the blood sugars to shoot up necesiting the start of injection insulin.usually insulin is started during intraoperative period and continued in the post operative period till it normalizates.on an average the injection insulin dosage is fixed and patient is sent home on fixed dosage of injection insulin.the patients returns back from home for regular check up then the injection insulin is coverted to oral hypoglycemics drugs.



its been observed that the patients who return to their normal lifestyle earlier get control of blood sugars early.