Chairman, Cardiac Sciences, Fortis Hospital, Noida
Part 8 of 8 in Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
A Cardiac Surgeon's Guide to Preventing Heart Disease
December 1, 2024
Asked what a healthy person should actually do to protect their heart, Dr. Ajay Kaul, Chairman of Cardiac Sciences at Fortis Hospital, Noida, gave a structured answer rather than a generic list, closing out his Jivo Healthcare masterclass for doctors across Africa with a framework that separates what a patient can and cannot control.
What Cannot Be Changed
Three risk factors sit outside a patient's control entirely, according to Dr. Kaul: genetics (a family history of coronary artery disease, hypertension or diabetes), age, and sex, since certain conditions are more common in one sex than the other. None of these can be chosen or avoided, only accounted for.
What Can Be Partially Managed
A second category can be reduced but not eliminated. Living in a heavily polluted city is one example Dr. Kaul raised directly; changing that is not always realistic, but it is worth doing where possible. A chronically stressful job or personal relationship is another: his advice was blunt, that this kind of sustained stress can itself contribute to a heart attack, and is worth changing where a patient has the choice to.
What Is Entirely Preventable
The third category is fully within a patient's control, and Dr. Kaul was most direct here. Smoking has no offsetting benefit whatsoever, and chewing tobacco is equally damaging, harming the heart and lungs in one form and adding oral cancer risk in the other. Alcohol should be limited to two or three drinks, two or three times a week, since drinking beyond that burdens the liver over time. On exercise, his specific, repeatable advice was to cover at least 10,000 steps a day, to take the stairs down even if using the lift up, to avoid junk food, and that the single best form of exercise available is a 3-kilometer walk in 30 minutes, twice a day.
When to Get a Cardiac Checkup, Before There Are Symptoms
Dr. Kaul's screening advice was equally specific. A patient with a family history of heart disease or diabetes should get a full cardiac checkup by age 20; a patient without that family history should still get one by age 40. And before starting any strenuous new exercise routine, such as joining a gym, a proper cardiac checkup should come first, because a diseased heart frequently gives no warning symptoms at all until it fails outright, the same way a car needs periodic servicing regardless of how well it seems to be running.
This guide is based on a live Jivo Masterclass: Dr. Ajay Kaul taught doctors across Africa on December 1, 2024.
FROM THE LIVE Q&A
Moderator
Is heterozygous (mismatched donor-recipient) heart transplantation possible?
Dr. Ajay Kaul
It is technically possible, but very few doctors would attempt it. A heart is a precious, scarce organ with a long waiting list of patients, so we always give it to the best-matching recipient rather than risk it in a less compatible match where rejection is more likely.
Frequently Asked Questions
What happens to the donor in a heart transplant?▼
The donor is already dead by the time of donation. It is not a live donation, so nothing happens to the donor.
What can someone who is currently healthy do in everyday life to keep their heart healthy?▼
Some factors cannot be changed: genetics (a family history of coronary artery disease, hypertension or diabetes), age, and sex. Some factors are partially avoidable, like living in a polluted city or staying in a highly stressful job or relationship. The fully preventable factors are the most important: smoking or chewing tobacco has no offsetting benefit and damages the heart, lungs or mouth; alcohol should be limited to two or three drinks, two or three times a week; walking at least 10,000 steps a day and taking the stairs down instead of the lift helps; and the single best exercise is a 3-kilometer walk in 30 minutes, twice a day. On checkups: if there is a family history of heart disease or diabetes, get a cardiac checkup from age 20; if there is no family history, get one by age 40. And before starting any strenuous new exercise routine, such as joining a gym, get a cardiac checkup first, because the heart often gives no warning symptoms until it fails outright, the same way a car needs servicing even when it seems to be running fine.
Does a transplant recipient have to stay on rejection-suppression therapy, and what is the average monthly cost?▼
Yes, anyone who has had an organ transplant, whether liver, lung, or heart, has to remain on anti-rejection therapy. In India, that costs on average about 25,000 to 35,000 rupees a month, and can range from about 20,000 up to 50,000. I'm not able to speak to what it costs in other countries.
Most chest abnormalities are often confused with cardiac disease. What is the major difference between the two?▼
The chest includes the lungs, the esophagus, the heart, and the blood vessels. What we are discussing today covers only diseases of the heart and blood vessels, not lung disease, muscular disease, disease of the bones or spine, or even the breast, even though these are also considered part of the chest.
What innovative treatments are available for patients with Eisenmenger syndrome?▼
Eisenmenger syndrome develops when an operable heart condition is left untreated for long enough that it damages the lungs, eventually making the lungs too stiff for any treatment to help. At that stage, the only option is a combined heart and lung transplant. It is a very difficult treatment, and the success rate is only around 40 to 50 percent.
What heart disease risk factors cannot be changed?▼
Genetics, age and sex, according to Dr. Kaul.
At what age should someone get a cardiac checkup?▼
By age 20 if there is a family history of heart disease or diabetes, or by age 40 if there is not.
What is the single best form of exercise for heart health, per Dr. Kaul?▼
A 3-kilometer walk in 30 minutes, twice a day.
In This Series: Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
- 1.Transforming Cardiac Care
- 2.Minimally Invasive Cardiac Surgery: A New Standard for Heart Operations
- 3.Valve Replacement and Coronary Bypass Surgery Without a Full Sternotomy
- 4.Treating Aortic and Carotid Aneurysms With a Minimally Invasive Stent
- 5.Heart Failure and the Case for Heart Transplantation
- 6.The Artificial Heart (LVAD): A Bridge to Transplant
- 7.Tetralogy of Fallot and Eisenmenger Syndrome: Two Very Different Outcomes
- 8.A Cardiac Surgeon's Guide to Preventing Heart Disease