New Delhi: 21st November, 2018: Age did matter until a decade ago when one talked of heart diseases because it is a major factor which is conducive to contribute to problems of the heart. With factors like stress, sedentary lifestyles and bad schedules contributing in the current times to several health problems in the younger generations, heart diseases have become a common occurrence in the younger population.
Heart Diseases are moving to a younger age; WHO reports a spike of 10% in cardiovascular diseases in the younger population in India
When Prakash (name changed), 32 years of age, a resident of Satna was presented to Dr Yugal K Mishra at Manipal Hospital, Sec 6, Dwarka, the symptoms were clearly indicating that the patient urgently required Coronary Artery Bypass Graft. He came with severe chest pain, shortness of breath, severe tiredness and palpitations.
When a patient suffers a heart attack certain areas in the heart do not receive enough oxygen and nutrients due to inadequate supply of blood in these areas. Through the CABG surgery these areas are re-perfused by using a free vein or arterial bypass. This connects the normal areas of the heart to the perfused ones bypassing the blocked arteries. The free vein or arteries are harvested from other parts of the patient’s body like the leg or femur or the arm or even from the chest area itself.
Dr Yugal K Mishra, Head Cardiac Sciences and Chief Cardio Vascular Surgeon, Manipal Hospitals, Dwarka, New Delhi says, “The patient being a young man at 32 years of age, our goal was to adopt the surgical procedure that would get him back on his feet at the earliest. The minimally invasive surgical procedure not only ensures minimal blood loss, it also has a shorter recovery period for the patient with a short stay at the hospital as well. The conventional method of a bypass grafting would be to cut through the rib cage or sternum which means cutting through the chest bones. This method aims at decreasing the invasiveness of conventional CABG while preserving the applicability and durability of surgical revascularization.”
Although several risk factors have been suggested; smoking and other forms of tobacco, dyslipidemia or high blood lipid levels and hypertension are major risk factors in the young.
Dr Mishra reveals, “The average age of patients who require CABG is moving to a much younger age. Research has come up with shocking numbers. As compared to the mid-nineties, there were about 10,000 CABG surgeries performed annually in India. Current numbers indicate a very significant rise over those numbers and reports reveal that about 60000 surgeries are conducted annually today. The age in my experience has moved down to patients between 20 – 40 years and this is an alarming number. By 2015, 62 million Indians were reported to suffer CAD of which 23 million are reported to be below 40 years. Projection suggests that by 2025 there will be a further increase in CAD by 25%.”
With upgraded technology and innovations surgery on the heart can also be performed when it is still beating or pumping blood and this is called Off-pump Coronary Bypass (OPCAB) Surgery. This procedure can be done in a majority of the patients.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is done without the use of the perfusion pump. As the name suggests, the incision is made relatively smaller and on the left side of the chest, closer to the heart. A small portion of the rib is removed to access the heart. This can be performed only on patients who need just one or two grafts on the arteries that are in close proximity to the incision.
Dr Yugal K Mishra says, “Lifestyle modifications and rapid urbanization has led to an explosion of cardiac diseases in India. With developing technologies and innovative methods in surgeries, doctors are able to provide better quality in cardiac care especially where such care is required urgently in high risk surgeries. In my experience I have treated so many patients in whom the majority has been CABGs and Valve Replacement cases.”
Global incidences of cardiovascular diseases have shown a spike and this is continuously on the rise especially in developing countries. This is the status in India as a developing country as well where coronary artery diseases have doubled over the past three decades as sharply opposed to developed countries where it has declined to almost 50%. Surveys have revealed that the increase in the disease under 35 years is projected at 10%. The past three decades have also recorded marked increase in risk factors including diabetes mellitus, hypertension, dyslipidemia etc. Metabolic syndrome which is a constellation of several cardiovascular risk factors viz. hypertension, obesity, impaired glucose tolerance, increased triglycerides, low HDL cholesterol etc. has also become common in India.