Surviving Heart Attacks: The Importance of Cardiac Collateralisation
The Heart is a muscle and any muscle requires a blood supply to function. The heart is supplied by 2 main blood vessels. The left coronary artery and the right coronary artery. The left further divides into 2 large branches: The left anterior descending artery (LAD) and the left circumflex artery. Each of these vessels supply a part of the heart and in combination, these 3 vessels supply the whole [...]
What is Care
The concept of ‘caring’ in medicine can be metaphorically likened to actively choosing to walk the patient home. However ‘home’ in this setting refers to the place the patient calls home - Caring is not about walking the patient to the place that the doctor calls home. This is fundamentally the problem with modern day medical care. We try and walk the patient to ‘our home’ and not to ‘their’ h [...]
A Higher Form of Truth
Several years ago, I was invited to join a fellowship program at one of the most prestigious cardiac institutions in the USA. I recall that time as one filled with great joy (because I thought it would greatly help my career) but also in part tainted with some trepidation (because this place only attracted the best of best and I didnt think I was bright enough to be mingling with such people). I [...]
Clinical Guideines: The refuge of the destitute
The modern age of clinical guidelines began with a 1992 institute of medicine report which defined guidelines as systematically developed statements meant to assist practitioner and patient decisions about healthcare for specific clinical circumstances. The key words there were ‘assist practitioner AND patient decisions’. However over the course of the last 30 years, this seemingly innocuous and p [...]
How to wean off Beta-blockers
A lot of people have contacted me and asked me as to how to safely stop Beta blockers and therefore I thought I would do a quick blog on this subject. I would like to stress that you should only alter the dosage or stop Beta-blocker usage with the explicit consent of your usual healthcare provider as they will know about your unique clinical situation and all I am doing in this vlog is just givin [...]
Cryptogenic Stroke
Today’s video is on the subject of stroke and in particular cryptogenic strokes. A stroke is often a devastating occurrence for several reasons: A stroke can be life threatening and stroke is widely recognised as a leading cause of death worldwide A stroke can be disabling and can destroy a person’s quality of life A stroke can recur and cause more damage/death the next time. It is therefore cruc [...]
Pericarditis
Pericarditis refers to inflammation of the pericardium The pericardium is a sac within which the heart sits. This sac has 2 layers- known as the visceral and parietal layers separated by a potential space which contains about 10-50mls of fluid. Acute inflammation of this sac is known as acute pericarditis. If the inflammation spreads to the surface of the heart itself, it is termed myopericarditis [...]
The three things that can go wrong with the heart
At first glance, the subject of heart disease can seem exceptionally complex - consisting of several different conditions, medical jargon and very scary sounding terminology. However when we really examine heart disease closely there are in general mainly 3 things that can go wrong with the heart and cause harm and if we know this then we are able to firstly understand the different conditions be [...]
The Great Medication Lottery
A lady in her 60s recently consulted me. She was extremely concerned because she was facing a dilemma and she did not know what to do. Basically she had been to see her GP and because her cholesterol was found to be a little on the higher side, she was being strongly advised by her GP to take a Statin. My patient did not want to take Statins. Her argument was that she had never had a problem with [...]
MINOCA : When a heart attack is not a heart attack
The term MINOCA stands for Myocardial infarction with non-obstructive coronary arteries. I'll try and explain this a bit better by using a case study. A 50-year-old lady was admitted to my hospital with crushing chest tightness. She had an ECG which suggested changes in keeping with a lack of blood getting to the heart. She had a blood test to measure Troponin. Troponins are enzymes released from [...]
WHAT EXACTLY IS AN ARRHYTHMIA?
The word arrhythmia comes from two Greek words. The first is ‘a-’ which means absence or loss and the second is ‘rhythmos’ which means rhythm. So arrhythmia literally means absence or loss of rhythm. A cardiac arrhythmia therefore means loss of cardiac rhythm. It is however used in medical practice as a description for disturbance rather than absence of heart rhythm. In that sense, the term dysrhy [...]
WELCOME TO THE PRIMARY BANK OF ASPIRIN
My name is Sanjay Gupta and in my last video, I decried the over-zealous prescription of medications which may have no or limited benefit for the patient. In this video, I wanted to explore this further with respect to Aspirin which is commonly prescribed for prevention or treatment of heart disease. This video is enigmatically entitled ‘Welcome to the primary Bank of Aspirin’. The best banks to p [...]
A potentially transformative treatment for POTS/Long COVID.
What is POTS? POTS stands for postural orthostatic tachycardia syndrome. In this condition, patients complain when they stand up for a prolonged period of time, they feel very uncomfortable with dizziness, palpitations and tremulousness and therefore they either have to sit or lie down or they risk collapsing. When you examine them, the heart rate can be found to be excessively fast. As doctors, [...]
Resynchronising the Heart in Heart Failure
You can download this script as a Hindi translation here. Today’s vlog is on the subject of heart failure and in particular on a special type of pacemaker which can make a significant improvement to the quality of life and length of life in patients with heart failure. What is heart failure? The heart is a pump and if the heart is in some way damaged - be that by a heart attack or a virus or harmf [...]
Leaky Heart Valves
We are blessed with 4 heart valves - 2 on the left side which are known as the mitral and aortic valves and 2 on the right side - the tricuspid and pulmonary valves. Sometimes due to a congenital problem, age related changes or even an acquired cause, these valves can start leaking and when they do so to a severe extent, they can adversely impact on a patient’s quality of life as well as their [...]
Heart Failure – Does Testosterone Hold the Key?
One of the reasons I wanted to start this channel was because of my frustration at how limited we were when it came to treating heart disease patients. Of course one of the reasons for this is that we simply don't know enough but another reason was that medicine as a whole has become very defensive. Offer the patient only those therapies which are recommended by clinical guidelines because that is [...]
The Management of Chronic Disease
I wanted to tell you a story about a patient who recently contacted me for advice. This particular lady was in her 50s in a very prestigious and high powered post and completely fit and well. She was married, had a daughter in Australia and had a wonderful social life with hiking with her girlfriends. Around Xmas time in 2020, she developed a flu-like illness and after that she started noticing t [...]
What do heart tests tell us?
Broadly speaking there are 3 things that can go wrong with the heart. The heart is a pump and that pump may be faulty either due to congenital problem or an acquired problem. If the pump is in any way defective then not as much blood comes out of the heart and the body and all our vital organs will get less blood than they should and this could lead to harm. So cardiomyopathies, valve problems, my [...]
Lessons from Shane Warne’s death – A cardiologist’s perspective
As a doctor and cardiologist, I see heart attacks and death on a daily basis and after a while one gets used to it and it feels like nothing can shock anymore. However, I was completely shocked yesterday when I heard about Shane Warne’s death from a suspected heart attack. Firstly he was only 52. Secondly he was a world class athlete only a few years ago. Thirdly from the news it seems that he was [...]
AF and Dementia
The first thing I want to say is that unfortunately the practice of modern day medicine is largely servile to clinical guidelines. We decide how to treat a patient based on how someone else (i.e whoever wrote the guideline) tells us how to manage the patient. If we stick to the guideline, we feel that we are offering top quality care and we can defend ourselves in court. If we don't stick to the g [...]
Intracoronary Stents
Today’s video is on the subject of intracoronary stents. In this video, I will talk about what stents are, why they are used and what benefits and risks are associated with their implantation. The first thing to understand is that for most of us, as we get older, the major risk to our health will be progressive ‘wear and tear’ in our heart arteries (coronary arteries). There are 2 problems with t [...]
The Gender Gap: Women and heart disease
As a cardiologist, I am always thinking of heart health and heart disease. More recently, I was at a raucous party and I saw a bunch of overweight middle-aged men smoking, drinking and overeating and I couldn’t help thinking of all the damage that was potentially happening in their heart arteries. What was interesting however was that there were lots of similarly overweight, smoking and overeating [...]
POTS: The 4 pillars of management
POTS stands for Postural Orthostatic Tachycardia Syndrome. This means that patients with this condition find that they feel unwell with symptoms of tremulousness, dizziness and heart palpitations when they stand up. On objective assessment,there is an exaggerated and sustained increase in heart rate (> 30 beats/ per minute in adults; >40 beats per minute in children) compared to when the pat [...]
Heart attacks in the young: The case of Siddharth Shukla
My name is Sanjay Gupta and I am a cardiologist in York. Today’s blog is on the subject of heart attacks. As many of you have probably come to know, the whole of India is in mourning after one of its brightest TV and film stars, Siddharth Shukla, died suddenly at the age of only 40 years. Initial reports have suggested that Siddhartha died of a massive heart attack. Here was a wonderfully athlet [...]