CKM (Cardiovascular-Kidney-Metabolic)
Heart Attack
In many industrialized countries, the number one cause of death is attributed to cardiovascular disease.
What is a heart attack?
The heart muscle contracts about 70 to 80 times per minute to pump blood, delivering oxygen and nutrients to the body's organs.
However, if the blood supply to the heart muscle is blocked—often by clots in the coronary arteries—a myocardial infarction, or heart attack, can occur.
Heart attacks typically begin with symptoms like chest pain, discomfort, shortness of breath, or sweating. These symptoms can be subtle, causing some individuals to delay seeking help. Prompt medical attention is crucial, as heart attacks can be fatal.
What are the risk factors?
Key risk factors for a heart attack include:
• High blood pressure
• Smoking
• Lack of exercise
• Overweight
• High cholesterol
• Diabetes
What are the treatment goals?
The primary objective after a heart attack is to prevent further complications such as death, stroke, or another heart attack. This involves removing existing blood clots and, as a result, preventing new ones from forming. Bayer provides products that may benefit patients in these situations. It's essential for doctors and patients to explore all treatment options to ensure the most suitable care and medication.
Patient advice
Because individual responses to medications vary, it's important to consult your physician to determine the best treatment for you.
Heart Failure
Understanding chronic heart failure
"Not to be confused with a heart attack, which involves a sudden blockage of the heart's blood supply, heart failure is a gradual decline in the heart's ability to pump sufficient blood throughout the body."1
Risk factors associated with heart failure
Common symptoms of heart failure
Due to reduced blood circulation, individuals with heart failure may experience various symptoms, including:
• Chronic coughing, wheezing, or shortness of breath
• Dizziness
• Swelling in the legs and ankles (fluid retention)
• Reduced ability to exercise
“A heart failure diagnosis can be daunting and the right support is needed when it comes to navigating the road ahead. As doctors, it is important that we help those living with heart failure to understand how they can best manage their condition and closely monitor symptoms for signs of progression.” - Professor Carolyn Lam, Senior Consultant at the National Heart Centre Singapore & Professor of the Duke-NUS Cardiovascular Academic Clinical Program
Living with worsening heart failure
A change in symptoms is the body’s warning sign, emphasizing the need for prompt action.
What is worsening heart failure?
For many living with heart failure with reduced ejection fraction, symptoms can worsen despite following treatment guidelines5. This can lead to aggravation of symptoms like severe breathing difficulties which may lead to hospital visits, known as decompensation events or 'Worsening Heart Failure’ events6.
Key symptoms to look out for:
• Difficulty breathing
• Increased swelling
• Reduced exercise tolerance
If any symptoms worsen, contact your doctor immediately.
How to recognize a worsening event in heart failure?
When living with chronic heart failure, it's crucial to monitor any changes in symptoms, especially those mentioned below. If a change is detected or any concerns arise, it's important to contact a doctor immediately2. A change in symptoms serves as a warning signal from the body, and an early action can make a significant difference2.
How to manage worsening heart failure?
Managing Worsening Heart Failure involves medical treatments and lifestyle adjustments:
• Diet: Reduce salt, alcohol, and fat intake. Weight management might also be advised7.
• Exercise: Engage in gentle physical activity to alleviate symptoms and improve well-being7.
• Smoking: Quitting smoking can significantly benefit heart health7.
• Support System: Friends and family play a crucial role in managing the condition and reducing stress3.
• Doctor Conversations: Open communication with healthcare providers about symptoms and emotional well-being is essential.
Supporting someone with heart failure
Caring for someone with heart failure involves understanding the condition and recognizing changes in symptoms. Support can include7:
• Listening to their feelings, especially when they feel uncertain or afraid. Your support can help them cope with heart failure.
• Joining in on recommended lifestyle changes, it’s easier to make changes together.
• Facilitating them in following the doctor’s guidance and making the most of their treatment.
• Reminding them to take their medicine.
• Helping them remember the questions they want to ask their doctors, and help follow their advice.
• Scheduling regular follow-up visits after patients return home from the hospital. Be familiar with their management plan and help prevent their heart failure from worsening.
• Watching out for worsening events and encouraging them to contact their doctor as soon as changes are noticed.
• Encouraging them to keep all their appointments, attend follow-up visits after a worsening event; promoting a lower likelihood of rehospitalization.
Did you know?
|
References
|
Chronic Kidney Disease (CKD) is a common complication of diabetes and also increases the risk of heart disease.1 In people with Type 2 Diabetes, CKD is the leading cause of kidney failure worldwide.2
CKD develops slowly over months or years, leading to a gradual loss of kidney function.2,3 The kidneys help remove waste products and extra fluid from the blood. When CKD reaches an advanced stage, harmful waste and fluid start building up in the body.4
The disease progresses silently, and symptoms often appear only in later stages.5 Common signs may include tiredness, trouble sleeping, high blood pressure, swelling in the ankles, feet, or hands, itchy skin, and the presence of a protein called albumin in the urine.6
References
|
Did you know?
Diabetes: epidemiology & disease burden in India
India has more than 77 million adults living with diabetes, making it the second highest in the world. Factors like urbanization, lack of exercise, and unhealthy diets play a major role. Many people don't know they have diabetes, which can lead to serious health problems.1
Are you aware of the challenges associated with diabetes?
Managing diabetes comes with several challenges:
• Using treatments properly to control blood sugar, blood pressure, and cholesterol, and prevent complications.
• Teaching patients how to manage their diabetes on their own.
• Encouraging patients to make lifestyle changes and follow prescribed treatments.
• Addressing fears and myths about starting insulin early.
• Ensuring better healthcare access for people with long-term conditions.2
All of these highlight the importance of health screening. How often do you go for health check-ups?
Definition and types
Diabetes mellitus is a long-term condition in which blood sugar levels are too high.3 The main types include4:
• Type 1 Diabetes – In type 1 diabetes, the body's immune system wrongly attacks and destroys the cells in the pancreas that make insulin, stopping insulin production completely.
• Type 2 Diabetes – In type 2 diabetes, the insulin made by the pancreas either doesn't work properly or isn't enough, causing high blood sugar levels.
• Gestational Diabetes – Gestational diabetes is a type of diabetes that happens during pregnancy. It affects women who didn't have diabetes before.
• MODY (Maturity Onset Diabetes of the Young) – MODY is a rare type of diabetes that is different from both type 1 and type 2 diabetes and runs in families. It’s caused by a change in one gene.
How diabetes is diagnosed?
Diabetes is diagnosed through blood tests5:
• Fasting Blood Sugar (FPG): ≥ 126 mg/dL
• Postprandial Blood Sugar (PPG): ≥ 200 mg/dL (2 hours after a meal or glucose drink)
• HbA1c Test: ≥ 6.5% (shows average blood sugar over 3 months)
• Random Blood Sugar: ≥ 200 mg/dL with diabetes symptoms
Diabetes is diagnosed through various symptoms like6:
• Urinating often
• Feeling very thirsty
• Feeling very hungry - even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts/bruises that are slow to heal
• Weight loss - even though you are eating more (type 1)
• Tingling, pain, or numbness in the hands/feet (type 2)
Why is it important to treat diabetes?
If diabetes is not controlled, it can cause serious health problems and affect quality of life.7
Microvascular Complications (Small Blood Vessels Damage)
• Eyes (Retinopathy): High blood sugar can damage small blood vessels in the eyes, causing vision problems or even blindness.8
• Kidneys (Nephropathy): The small blood vessels in the kidneys get damaged, which can lead to kidney failure.9
• Nerves (Neuropathy): High blood sugar from diabetes can damage nerves and their blood supply, causing peripheral neuropathy.10
Macrovascular Complications (Large Blood Vessels Damage)
• Heart Disease: High blood sugar can damage blood vessels and nerves that control the heart. People with diabetes are more likely to have other conditions that increase the risk of heart disease.11
• Peripheral Artery Disease (PAD): PAD is similar to coronary artery disease (blockage in the arteries that supply blood to the heart) and carotid artery disease (blockage in the arteries leading to the brain). People with diabetes are already at a higher risk for PAD.12
How are Indian patients different?
Indian diabetic patients differ due to diet, lifestyle, and genetics.
• High-Carb Diet: Indian meals are rich in carbs (60-70% of daily intake), which can cause blood sugar spikes.13
• STARCH Study: A study on the carbohydrate intake of the Indian type-2 diabetes population confirms that excessive carbohydrate consumption worsens blood sugar control in Indians.13
• Early Onset: Diabetes develops about ten years earlier in Indians compared to people in Western countries.14
• Genetics: Indians have more body fat and less muscle than Europeans, which makes them more likely to develop insulin resistance and diabetes.15
The risk factors for developing diabetes in Indians include a family history, belly fat, insulin resistance, and lifestyle changes due to urbanization.14
Postprandial hyperglycemia: importance to address
The post-meal phase is marked by a quick and large rise in blood sugar levels. High blood sugar after meals (postprandial hyperglycemia) can damage arteries and increase the risk of heart disease. It is a direct and independent risk factor for cardiovascular disease (CVD). Managing blood sugar after meals is now an important part of preventing and controlling heart problems in diabetes.16
Guidelines and treatment algorithm
Diabetes management follows guidelines from global and Indian organizations like the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies (JBDS), American Association of Clinical Endocrinology (AACE), Diabetes Technology Society (DTS), and Indian Council of Medical Research (ICMR). Treatment includes lifestyle changes, oral diabetes medications, and insulin, depending on how severe is the disease.17-20
Role & Importance of Lifestyle Modifications and Dietary Changes
A structured lifestyle is essential for managing diabetes. Eating a balanced diet with fiber, whole grains, lean proteins, and fewer refined carbs helps control blood sugar. Regular exercise, maintaining a healthy weight, and managing stress are also important.22
Detecting diabetes early, starting treatment on time, Adherence (taking medications as per treating doctor’s advice), regular follow up. Regular monitoring of blood glucose levels and making lifestyle changes can significantly reduce its impact in India.23,24
References
|