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Have a heart, be kind to it
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Unhealthy lifestyles have contributed to a 30 per cent rise in cardiac problems in the city, according to Dr. Ashwath N. Rao.
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Photo: Sampath Kumar G.P.
Dr. Ashwath Rao keeping tabs on heartbeats.
THE SIXTH floor of Bangalore Hospital is shared by the Departments of Cardiology, Neurology, and Nephrology, besides the ICU. As you step out of the elevator, the tension of being on the edge of life hits you like a wall. The dialysis patients are equalled, if not outnumbered, by those requiring cardiac care. And they seem to be queuing up outside one rather modestly designed board that reads Dr. Ashwath N. Rao. Nothing more. No high-falutin' degrees to proclaim the doctor's background or explain why so many cardiac patients are cheered up merely because they can soon entrust their problems to him.
They wait long. Patiently. Because doctor is in the catheterisation (cath for short) lab doing a procedure, either an angiogram or angioplasty. The first to see if there are any blockages in the arteries; the second, to save lives by clearing the blocks. The procedure is minimally invasive, using the artery itself to insert a catheter to reach the block, instead of a major surgery. It lasts 30 to 40 minutes and is done mostly on an outpatient basis. Or he could suddenly appear from the cath lab, see a patient and then plunge into the echo stress room to find out how well another patient's heart is coping.
Dr. Rao sees almost 30 patients a day. He rues the rising incidence of cardiac-associated health problems in India, and is setting up a cardiac care facility in Malleswaram, where he lives and where he feels cardiac attention isn't easily accessible. Especially considering the time between a heart attack and the first medical attention is crucial in saving lives.
Dr. Rao got his degree in 1974 from St. John's Medical College, went on to study at Phoenix, Arizona, and worked at Mt. Sinai, Miami Beach, and Hutchison, Kansas. He specialised in cardiology and catheterisation. He also studied pulmonary diseases and critical care medicine. He came back to India when Bangalore Hospital was at the stage of inception.
Dr. Rao is a promoter of the hospital and is also talking to it authorities about collaboration for his new cardiac centre. Large, highly populated areas need more than one cath lab. North Bangalore has a paucity of them. Yeshwantpur and Peenya, he says, are not covered.
So, how many cath units does Bangalore require? A free economy, he says, will find its own level. Like in Mysore, which has three, one of which he helped set up. Bangalore has 14. And about 200 practising cath surgeons. Cath equipment is still not available in the country.
This is how he looks at his job:
Do you travel a lot to the U.S. in search of equipment?
Not only equipment but also to attend conferences. In order to continue medical education and keep up with medical practices and for wider exposure to a variety of procedures. There are still problems in procurement and import of cardiac equipment. There is talk of making some in Hyderabad, but there isn't much work done on it as such.
Do you read a lot? (He has answers to a wide range of health problems.)
Whenever I have an opportunity.
Did studying abroad get you this far into specialisation, or do the same opportunities for specialisation exist here in India?
Studying in India would have been fine. But I did have a great deal of exposure and experience opened up to me in the United States.
You were talking of a rising incidence of cardiac problems in India. What is that due to? Bad lifestyles, abuse of antibiotics, autoimmunity problems?
Yes, of late, there has been a 30 per cent increase in cardiac problems. Bad lifestyles and sedentary practices lead to bad hearts. People under stress are highly prone to heart attacks. Antibiotics and autoimmunity problems have a very small percentage of influence on the heart. It is exceedingly uncommon for them to affect the heart directly. Loss of physical activity is the main cause for rising levels of cholesterol. Lack of exercise translates into lack of cardiac exercise. In addition, there is a tendency to overeat or to eat food heavy in cholesterol. Increase in bad cholesterol and drop in good cholesterol lead to blood vessel walls getting encrusted. This grows into complicated blockage and heart attacks.
What is the future of catheterisation? What research is going into it?
In diagnostic catheterisation, the research is relatively minor. Right now, interventional catheterisation is still improving and growing. Catheter sizes are getting smaller, so there is less pain and discomfort during a procedure. And most of these are outpatient procedures. The patient undergoes an angiogram, for example, and goes home three to four hours later. Wires and stents have improved.
There is interest in coated stents. These are metallic devices, springs, used to remove blocks. Some of them block up six months after implantation. The artery reacts to injury or the stent itself... all sorts of theories abound. Of such reactions, around 10 per cent happen in non-diabetics, 20 to 25 percent in diabetics and the incidence can be reduced by various techniques. One of them is to use coated stents. A compound called Sirolimus is used as a coating. It is an expensive antibiotic and has a six per cent prevention rate of restenonis (which is a re-narrowing or blockage of an artery at the same site where treatment, such as an angioplasty or stent procedure, has already taken place).
Dr. Rao can be consulted at Bangalore Hospital (Ph: 656 3477) between 10 a.m and 2 p.m. daily except Thursdays.
S. SUCHITRA LATA
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Metro Plus
Bangalore
Chennai
Coimbatore
Delhi
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Kochi
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Visakhapatnam
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