“First of all, a daily fitness schedule conditions the muscles and tissues in such a manner that they can expand and withstand the stress of less oxygen in the blood. The heart functioning, like that of any other muscle, depends on an energy currency called ATP or adenosine triphosphate. And a regular and moderate exercise regime helps store some energy in your muscles at any given point of time. This stored amount helps your body fight back in times of crisis. Our body inherently has an anti-coagulant system and there is a constant tussle with the pro-coagulant or clotting system. And when the muscles are in a good condition, the blood flow is good and arteries can even open up on their own. A patient’s survival depends on the blood flow to the heart during a cardiac episode. Doctors’ efforts are to restore the blood flow as early as possible. She came in with good blood flow and I would say that over 90 per cent of heart patients that come in do not have good blood flow,” says he.

THE BENEFITS OF EXERCISE

Since the blood and oxygen supply is cut off, the muscle cells of the heart begin to suffer damage and start to die. Irreversible damage begins within 30 minutes of blockage. “Exercise increases the ability of muscles to get more oxygen out of the blood, reducing the need for the heart to pump more blood to the muscles. It reduces stress hormones that can put an extra burden on the heart. It can help you lower blood pressure, increase high-density lipoprotein (HDL) or ‘good’ cholesterol and helps control triglycerides. There is research too that shows that people who exercise regularly are less likely to suffer a sudden heart attack or other life-threatening cardiac events. Exercise keeps arteries healthy and even dodge the effects of ageing,” says Dr Bhagwat. He recommends aerobic exercises like brisk walking, jogging and swimming, as good for preventing and managing heart disease. A Harvard Medical school report says that in “response to regular exercise, muscles actually grow more blood vessels by expanding the network of capillaries. In turn, muscle cells boost levels of the enzymes that allow them to use oxygen to generate energy. More oxygen-rich blood and more efficient metabolism: It’s the formula that explains why people who exercise regularly enhance their endurance and strength.”

POST HEART ATTACK EXERCISE AND CARE REGIME

He advises the need for a cardiac rehabilitation programme for anybody who has had a heart attack. “This is of utmost importance because every plan is customised as per the patient’s case history and this process is very important not only for recovery but for the prevention of future episodes. You need to understand your heart rate and cannot overdo things. Stop and report any discomfort that you experience to your cardiologist,” advises Dr Bhagwat. So how early can one exercise after stenting? “It all depends on how well the heart is functioning. If there is minimal damage to the heart, then we can start as early as possible, maybe after seven days. But the process may be gradual if the patient’s BP is high or there is significant damage,” he adds.

While exercise has its benefits, the best way to prevent heart disease and maintain its functioning is to have a healthy diet. “I always tell my patients that our traditional oils like groundnut oils are good provided we do not burn and overheat them during the cooking process. We must get used to the idea of minimally heating the oil for our food preparation. Include plenty of coloured vegetables that are rich in anti-oxidants, vitamins and micronutrients. In this respect the Indian concept of thali works best, representing each food group. Besides, follow the golden rule of eating less, remaining hungry and living longer,” says Dr Bhagwat.

DO WE NEED TO WORRY ABOUT STENT BLOCKAGES IN THE FUTURE?

Nowadays, the technical quality of stents is much improved, assures Dr Bhagwat. “It just has to be deployed rightly with the right expertise. Taking medication and following the cardiac rehabilitation plan should go a long way in preventing disease recurrence. There is a higher risk of recurrence in people who do not control their diabetes or cholesterol levels well enough,” he adds.

WHY ARE YOUNGER WOMEN BECOMING MORE PRONE TO HEART ATTACKS DESPITE BEING IN THEIR REPRODUCTIVE AGE?

“It is true that the female hormone estrogen prevents heart attacks. So clearly there are other triggers that are overtaking the protective effect. First is family history that we may not be aware of. Second is the rising stress that younger women are exposed to than say two decades ago. They are internalising stress resulting from exacting work schedules and coping with family demands where they rarely have much support in sharing care responsibilities and chores. Over time, no matter how fit you are or how good your estrogen is working, stress and strain can be silent killers. They stimulate production of adrenaline and cortisol, which result in inflammation of arteries and formation of atherosclerotic plaque and thrombus or blood clots. Third is diabetes, which I feel is so ignored in the early part of your life that by the time it is diagnosed, it has already damaged your body somewhat. Generally, diabetes is also associated with obesity, hypertension and deranged lipid levels which together increase the risk of heart attacks significantly. Fourth is the increased incidence of smoking, which is often uncontrolled and stress-induced among the younger age group. Fifth is the overuse of oral hormone pills. Studies have shown how hormones in birth control pills can raise your blood pressure if you are hypertensive. Most women do not get their BP checked before they start popping the pills. These often change the blood fats; levels of HDL could go down while those of LDL and triglycerides could go up. All such pills must be taken in consultation with a medical practitioner,” says Dr Bhagwat.

UNDERSTANDING CARDIAC RISKS OF MENOPAUSE

After menopause, women catch up with men very fast and are just as much at risk, reporting high levels of cholesterol and triglycerides. “By 60, women overtake men many times over in terms of heart attack risk. In fact, the risk goes down gradually in men in their senior years while it keeps going up and up for women,” he explains.

WHY SHOULD ALL INDIANS DEVELOP MEDICAL AWARENESS?

Given that we are topping all markers of non-communicable diseases, developing diabetes, hypertension and heart conditions earlier than people in other parts of the world, Dr Bhagwat feels there should be an awareness built up from our educational institutions and in our neighbourhoods. “The cardinal rule is that Indians should get themselves tested from age 30, age 25 if they have a family history of diabetes and heart disease. The markers can be identified early enough and there can be a corrective course. We must ensure that there is awareness about CPR (cardio-pulmonary resuscitation) in schools and we must have defibrillators in public spaces and societies,” suggests Dr Bhagwat. “Prevention is in our hands really and it is not that tough to begin early and minimise risks in our advancing years,” he adds.