Mass Screening is Must to Avert Heart Catastrophe in India- Dr. Naresh Trehan
As internationally renowned heart surgeon, the iconic Dr. Naresh Trehan has as if ownership of all hearts under the Indian sun. In Medanta Medicity at Gurgaon, he has created a metaphor for ultimate excellence in treatment for all diseases. As he himself paraphrases the name, Medanta stands for end of medicine. Lest you misconstrue, he means to say- if Medanta does not have solution for your ailment, be sure you would get it nowhere – Medanta is ultimate in medicine.
And the brand equity that he is, he suffers from the problem of plenty. He is always hard up of time due to plenty of patients waiting to see him. Unless they see him, patients’ worries know no end. His reassuring words have instant calming of the patients. Hence, as always, this time too, on 24 September, Meditoall editor in chief Dhananjay had to be in his chamber almost 3 hours for the staggered interview- 5 or 6 patients for one question. Patient is always a first priority for Dr. Trehan, whosoever non- patient high and mighty is in the waiting area.
In the run up to World Heart Day on September 29, Dr. Trehan expresses his worries about the impending heart catastrophe and stresses the urgent need for mass screening up to village to identify the risk factors and facilitate intervention done at the earliest to avert that catastrophe. He says it is a double whammy on Indian hearts, one congenitally narrowed arteries and other diabetes. It is a fatal combination. He advocates second opinion in treatment if time allows for protecting heart patients from greedy doctors and unethical practices.
Excerpts of the interview
Chest pain is one of the symptoms of heart in distress. If that pain is really the symptom of heart, it is dangerous. One must get it checked whether it is symptom of the heart or not. You cannot evade the test. Yes, question of protecting patients from becoming captive remains. I think if the patient has time, he should take a second opinion to clear the doubt.
I want patients should be knowledgeable. Normally ECG and some blood test can identify whether the pain relates to heart or not. In case these do not help, then the need of angiography arises.
On the eve of World Heart Day, what are your tips for keeping heart healthy and ticking in perfect rhythm?
5 days a week, 40 to 50 minute exercise and at least 4 kilometer walk is very good for heart. One must learn some de-stressing technique because stress is a serious risk factor. Yoga’s breathing technique is very good for heart too. I am happy that mass media has made people in general aware of dangers for heart and they are sufficiently sensitized and I hope they have started caring to keep heart healthy.
Keep this in mind- If any one of your parents has heart ailment, there are 25 percent chances that you would have that problem too. If both mother and father have heart problems, the risk for you to get that doubles. If there is no heart ailment history in the family, it is very good. Such people should do following things to keep heart ailment at bay- First, take care of what you are eating. Fried food items should rarely be on your menu. You must be frugal about sweets. Sweets are no good at all. Much use of milk and other dairy products too are not advisable. Have enough fruits and vegetables. Bread made up of mixed flour is very good.
You have created a blueprint for ‘health for all’, a goal post shifted many a time. You seem to be confident that the present union government has motivation to implement. What is your blue print for hearts?
What I feared about heart ailments in India twenty years ago is staring us in the eyes today. That nightmare has translated into reality. We have highest number of heart patients in the world. Diabetes is compounding the problem all the more. Diabetes is also escalating. It is a matter of concern because diabetes decimates vital organs of the body. The burden of heart ailments is having very adverse social and economic fallout. Earning members of the family are becoming crippled. Loss of man hours have amounted to Rs 300 billion.
How do you think the impending heart catastrophe can be averted?
The government will have to take urgent steps. All should be checked at attainment of 30 years of age to find out if there are any risk factors or not. The government should undertake mass screening to identify risk factors for heart and intervening early. The awareness about heart and screening should percolate down to village level. High cholesterol, diabetes high blood pressure and obesity are risk factors that should be evaluated for sure. Just as one attains the age of 30, one heart check is must. People are found having blood sugar escalated to 400. Still they are unaware of it. Such state of ignorance is worrisome. Not only heart, diabetes wreaks havoc on every vital organ of the body. Heart must be hedged from diabetes at all cost.
How is bypass doing? What are new age bypass? Can bypass be ever bypassed as angioplasty experts often say this as a barb at this mode?
For bypass, many new techniques have emerged with minimal invasive procedure. If there are multiple blockages in the coronary arteries, 50 percent of them can be treated with new age bypass. And forget the taunt- bypass can be bypassed. It can never be bypassed.
We often hear about clash among cardiologist, bypass surgeon and angioplasty expert. Cardiologist says he can treat a particular patient with medicines, surgeon claim he is the best bet and angioplasty expert claim to be best suited. What is the way out to decide?
Yes, sometimes claims clash and need to choose from options arise. There should be a board or heart team, as we practice in Medanta and as there is tumor board for cancer, to decide which one mode is the best suited. We discuss among us and finally pick up the best suited mode. That is how it should be done everywhere.
Percentage of blockage in coronary arteries is a grey area. This is a conundrum of sorts. What is the critical stage of blockage?
Normally nothing needs to be done till blockage is 70 percent. Some of them for sure need visual estimation. For some of them we get thallium test done to ascertain risk. They can be treated with medicines only.
In the light of the allegations of angioplasty or heart surgeries being done without the need just to make money, are you in favor of audit of heart procedures to check this?
Yes, audit must be done to protect the patients from unscrupulous health providers. It is very necessary to expose them through audit. Angioplasty and bypass surgery are very useful and life saving procedures but they have landed in controversy due to some black sheep in the profession.