Tell us about your experiences in cardiology in your career thus far?
“Career” as such is a vexed term. I feel I am still a learner in the huge ocean of cardiology. However, my experience in cardiology, starting from my PGI days, has been an exhilarating one. I have seen, developed, learned, and gradually grown with modern cardiology. The Army gave me ample ground and support in my early days. Currently, I am practicing “niche” cardiology procedures in one of the best (cardiac) centres of India.
What are your suggestions for maintenance of a healthy heart?
For a healthy heart, it is very important to do away with reversible risk factors such as smoking and stress. It is also important to have a proper prevention, check, control, and treatment plan for hypertension and Type 2 Diabetes Mellitus etc, which are partially reversible. With effective lifestyle changes, it is possible to keep hypertension and Type 2 Diabetes Mellitus at bay. One should be vigilant and observant and check for early signs of heart disease.
What are your memorable experiences in this field?
I have many memorable experiences. I have treated very young heart patients and even attended to a father-son duo simultaneously.
How do lifestyle changes weaken the heart?
Adoption of the so-called “modern” urban lifestyle by the population does predispose us to development of hypertension and Diabetes.
Remember that as Indians, we are predisposed to earlier development of Coronary Angiography by about 10-15 years, as compared to the Western population.
What remedies do you propose for a heart patient?
We need to have a comprehensive health plan and ensure effective implementation of our projects. We have to delve deeply into the question of addressing the magnitude of our problem and formulate an effective and workable policy. We have to make effective dietary and lifestyle changes to prevent and delay development to Diabetes Mellitus and hypertension. We have to promote smoking cessation, salt restriction, diminish saturated and trans fats in diet, and take to a fitness regimen.
It may sound utopian, but a blanket ban on sale and consumption of all tobacco products and elimination of trans fats should be our goal. The medical fraternity and the community at large should be partners in this noble project. We should be emphasising more on primordial and primary prevention rather than only secondary and tertiary care, which is currently the flavour. Perhaps, we should be targeting mothers and children for effective health promotion and preventive care.
What kind of food habits are considered healthy?
Now, that is an area of conjecture. According to studies, a Mediterranean type of diet has been found to be the best. It allows intake of plenty of fresh fruits and vegetables, fats on moderation, restriction of carbohydrates, rich protein, particularly fish and marine sources, limited consumption of meat, and high dairy products and nuts.
One thing is clear that a high carbohydrate diet is harmful. Carbohydrates should constitute less than 50 per cent of our energy requirements, fats should be in the range of 30-35 per cent and proteins making up for the rest. We also have to reduce trans fats from diets. One effective way to do that will be to cut away all stored and processed food from diet. Care should actually start from early childhood for effective prevention.
What should one do for a healthy lifestyle?
For a healthy lifestyle, we should:
· Quit smoking and eliminate tobacco products.
· Limit alcohol intake.
· Promote physical activity.
· Reduce the component of stress in our life.
How huge is the burden of cardiac diseases in India?
The burden of Coronary Artery Disease/heart diseases are alarmingly increasing in India. By 2015, we are projected to have about 64 million heart patients going by conservative estimates. The current data available is of 2005, when we had about 34 million heart patients. This is only the tip of iceberg. Many more are suffering from the ignominy of care. The number of sufferers has increased. There has been an increase in awareness, but that is limited as compared to the burden.
My personal analysis is that we are lagging behind in preventive care and provision of world class secondary level care at affordable costs. We should look at complete re-evaluation of our preventive policies.
Bypass patients with preserved cardiac function can aim at normal or near-normal lifespan. They have to quit smoking, take medicines regularly, and be vigilant about their symptoms and care. Bypass patients with compromised cardiac functions actually live lesser, but with effective medications, care, use of devices etc, their situation can be improved remarkably.
How effective are medicines?
We must understand that medications are not for complete cure. By effective medication, we can blunt the onslaught of diseases. With effective use of aspirin, statins, ACE inhibitor etc, we can reduce the brunt of Ischemic Heart Disease significantly. However, caution should be made of injudicious and unwanted medications as it can do more harm than good.
What are the common medications?
Common medications include aspirin and other anti-platelets, Statins, ACE inhibitor, Anti diabetics, Diuretics, Calcium channel blocker, Betablocker, and Digitalis.
Illustrious AFMC alumnus
Dr (Col) Manjinder Singh Sandhu graduated from Armed Forces Medical College in 1986. He did his MD (Medicine) from Pune University and DNB (Medicine) in 1993. He was awarded the gold medal in MD. He did his DM (Cardiology) from PGIMER, Chandigarh, in 2001. He had a distinguished career in the Army Medical Corps. His last posting was at Base Hospital, Delhi Cantonment, as Senior Adviser (Medicine and Cardiology). He also held the post of Additional Professor of Medicine and Cardiology at Army College of Medical Sciences, Delhi Cantonment. A Principal Investigator in research projects of the Department of Biotechnology, Ministry of Science and Technology, Govt of India, and Armed Forces Medical Research Committee, he has taught post-graduate students in Medicine and Cardiology. He has had the honour of being the accompanying Cardiologist to the President of India.
Dr Sandhu is an active member of the Association of Physicians of India, the Cardiological Society of India, the American Heart Association, the European Society of Cardiology, and the European Association of Percutaneous Interventions. He is a fellow of American College of Cardiology and Society for Cardiac Angiography and Interventions. His areas of expertise include complex coronary interventions, rotational atherectomy, transradial interventions, peripheral interventions (carotid and renal, device closure of congenital heart defects, pacemakers, ICDs and cardiac resynchronisation therapy implants), and Balloon Valvuloplasty.
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