Chest pain: Angina

Cardiac pain: Angina


Chest pain of any intensity should never be ignored. It should promptly be recognized, investigated and treated. The cardiac and vascular causes of chest pain can be fatal and so need to be promptly treated.


Chest pain can be due to a variety of reasons. It can be due to causes related to the heart, the lungs, food-pipe, spine and muscles.

Let us learn about how to differentiate between some of them!


 Some of the causes of chest pain are:


  • Cardiac pain: is also called Angina. It is caused by blockages in the heart blood vessels due to cholesterol deposition. The pain is classical in nature and easy to recognize. Most of the time it is described as heaviness in chest (compression or a tight feeling). Some of patient may have burning pain in chest. It increases on exercise. It decreases at rest. This is caused by blockages in the arteries which progress slowly over months and so called stable. The pain in this condition is called Stable Angina. They are confirmed by a test in which one exercises and the ECGs are monitored. The test is called treadmill stress test. Sometimes, the blockage gets complicated due to blood clot formation. This causes total occlusion of the artery and is riskier. The pain here is severe in intensity, sudden in onset and even at rest. It does not subside with routine medicines. It is called Unstable Angina. The condition is diagnosed by ECGs and blood tests. If not promptly treated, patients may progress to have a heart attack.


  • Lung pain: The covering layer of the lungs produces pain which is sharp and increases on deep breathing. This pain can be due to infection or other causes which need to be investigated. The lung tissues normally do not cause pain but can cause cough and breathlessness. Most of the time it is diagnosed by an X-ray of the chest and can be promptly treated.


  • Food-pipe/ Esophageal pain: This is caused by increased acidity and mild erosion of the food-pipe. The pain here is burning type, normally increases on an empty stomach. It is normally associated with belching and sour eructations. The test preferred is a Scopy of the upper gut where in a tube with a small camera is passed into the food-pipe to diagnose the problem. It is easily treated with antacids and drugs to reduce acid secretion.


  • Spine problems: Here, the pain is dull or sharp but always localized to the spine. It originates from the spine and most of the time radiates to the sides. Movement of the spine makes the pain worst. An X-ray or MRI of the spine may be necessary to assess the severity of the problem. Most of the time the pain subsides with medical treatment. It is relieved with analgesics and muscle relaxants.


  • Muscular pain: These are normally associated with soreness of the muscle and dull aching in nature. They are easy to recognize and so easily treatable with analgesic and some exercises.

These are the common causes of chest pain. One needs to be cautious when it is in the center of the chest and associated with breathlessness.




Exercise: The Best Medicine.

Exercise: The Best Medicine.

Let us talk about Exercise!

Tell me which is the cheapest medicine?

Exercise! And why is that?

Exercise has lots of advantages. Let us learn about its benefits!

  1. Exercise decreases blood pressure.
  2. Exercise reduces blood sugar levels.
  3. It decreases the incidence of diabetes.
  4. It improves lung and heart capacity.
  5. It improves exercise tolerance.
  6. It increases bone density making them stronger.
  7. Prevents age related osteoarthritis.
  8. It reduces joint problems, especially arthritis of the knees.
  9. It strengthens the spine.
  10. It improves mental health and elevates the mood.
  11.  It reduces anxiety.
  12. It reduces incidence of heart attacks and debilitating strokes.
  13. Reduces progression of dementia.
  14. It reduces frequency of angina in patients with coronary heart disease.
  15. It improves cardiac capacity in patients with heart failure (weak hearts).

The list of benefits is endless!

 And What is the best part?

It is totally FREE unlike a visit to the doctor or buying medicines. Does not cost a penny!

You just need to walk (brisk walking preferable) 30-45 minutes at least 5 times in a week!

So why would one not exercise! Its free and has so many benefits. So put on your walking shoes and move out of the door! Just walk! Just do it! Experience the benefits!

Good Luck! I am sure you will do well and soon start motivating others soon!

Heart Attack!

Heart Attack! A medical condition which evokes fear in the patients and their relatives.


What causes heart attacks? Are they fatal? Are there any measures which can save your life? What are the treatment options? What medicines to take after a heart attack? These are some of the common questions which most of us have regarding a heart attack. So let’s answer them!


What is a Heart Attack?


A Heart attack is a term applied to injury caused to the heart muscle due to sudden blockage of the artery carrying blood to the heart. The heart is a pump which pumps blood to the whole body. For this the heart needs oxygen which is supplied by three small blood vessels called coronary arteries. When one has sudden blockage of one of these arteries, it is called a heart attack. During the heart attack the artery gets suddenly blocked almost 100% by a blood clot and thus there is less blood supply to the heart. This causes damage to the heart muscle and can be fatal if it is severe.


What are the symptoms experienced by the patient?


The blocked artery causes damage to the heart muscle. This causes severe chest pain in the center of the chest. Some times the pain can radiate to the arms, back, upper part of the tummy and the jaw. Some patients may experience giddiness, palpitations, shortness of breath and sweating. Some patients may experience burning in the chest and stomach with nausea and vomiting. They may delay treatment thinking that it’s a gastric (acidity) problem.


Are all heart attacks fatal?


No. Most of them are not fatal. However, 25% of patients can die if the heart stops suddenly. This is called as Sudden Cardiac Arrest. Majority of the patients survive a heart attack but it needs to be treated promptly.


What can you do at home?


  1. Remain calm. Do not panic. Do not run. Rest and wait for the ambulance to arrive OR.
  2. Visit the nearest hospital with an ICU facility by a vehicle. Do not walk down to the hospital.
  3.  If you are breathless, sit upright.
  4. Chew 300 mg of Aspirin tablet. Or powder it and keep it below your tongue. Do not gulp it down with water
  5. If you have chest pain, place a 5 mg tablet of Sorbitrate below your tongue. Ensure that you are in a sitting position and do not stand if you are feeling giddy. One can place a maximum of 3 tablets below the tongue at 5 minute intervals. Do not take Sorbitrate if you are feeling giddy.
  6. Get an ECG immediately and report to the doctor.


How is a Heart Attack Diagnosed?


A Heart Attack is diagnosed by an ECG and a blood test called Troponin. Your ECG will show changes suggestive of less blood supply to the heart. A positive Troponin blood test also suggests decreased blood to the heart.


What are the treatment options?


A heart attack is caused by sudden total (100%) block of the coronary artery. So the main treatment goal is to open the artery. There are 2 ways by which one can open the artery.


1. Angioplasty. During angioplasty, the block is directly opened with a balloon and then a stent is placed in the artery.


2. Clot Buster Injection: This is the medical option called Thrombolysis. Here a Drug is administered intravenously to dissolve the clot and restore the blood supply to the heart. These vary in their charge from INR 2500 to 35000/-. Some of the drugs used are Streptokinase, Tenecteplase (available as Elaxim or Metalyse), and Reteplase etc.).



What other drugs are required subsequently?


Once a patient is stabilized, majority of them will be on the following drugs:

  1. Blood thinners: like Aspirin to improve blood flow.
  2. BP medicines: to control the blood pressure and decrease load on the heart.
  3. Statin: these are medicines to reduce cholesterol levels and prevent heart attacks
  4. Diabetes medicine: to control your diabetes.

All patients need regular follow up with a Cardiologist and Life-long Medications!

Take care of your heart! Chao!

Why am I not losing weight?

Most of my patients complain to me :  “I am unable to lose weight inspite of giving it my best shot?” 

Now, why is that?

Most of them follow diets which cannot be continued for long time or have bad eating habits or follow one of the below mentioned things.

Things that never work: 

Fasting for long hours.

Fasting for half a day.

Skipping their breakfast and other meals.

Eating once a day.

Liquid diets.

Taking supplements to lose weight.

Alternative diets

Getting on the vibrator belt/ using fancy exercise equipment to lose weight (vibrators).

Now why is that these things don’t work?

Its very simple! Lets get down to the basics!

Consider that you have a bucket and you are filling water in it from the top and draining some water from below. It you are filling it with more water than the amount of water you are draining, it is bound to fill up and overflow. It you are adding less water from the top and draining more water from the bottom, the bucket is going to be empty soon.

So, What does this tell you?

It tells us that Losing Weight is all about your intake and output. Your intake is in the form of food stuff that you consume/eat which adds up to calories in medical terms. The output is the calories you lose by performing your daily routine/ exercise.

So if one’s calorie intake is lower that the calorie expenditure, there is a 100% chance that one will reduce and lose weight.

So What do we do?

Follow the following!

A. Tips regarding eating to lose weight:

1. Eat Well! Do not Fast as that is not going to help.

2. Eat a healthy Breakfast! Very important! Lots of studies have proven that people who miss breakfast are likely to put on weight. So do no skip your breakfast!

3. What can you eat for breakfast? Fruits, Fruit juices, whole grain cereals, oats, muesli, sandwiches etc. I personally prefer Kellogg’s cereal with fruits added to it mixed in milk!

4. Eat frequent small meals! Eat 4-6 times in a day. The trick is to keep the tummy full and avoid hunger pangs. Hunger pangs make you overeat! But, it is important to eat healthy stuff when you are going to eat frequently. Options include fruits, salads, fish, white meat, sandwiches, snacks like nuts.

5. Eat Breakfast like a King, Lunch like a Prince and Dinner like a Pauper! So very true! Breakfast >> Lunch>> Dinner.  Add 2 more snacks in between them and that should suffice to make you lose weight.

6. Eat Healthy food stuff: Cereals, Whole grain foodstuff, Fresh fruits, Salads, nuts etc. Even cheese slices or dark chocolates would do as one of the snack.

7. Avoid Fried food, Fast food, refined flour, polished grains.

8.  Eat food stuff which is part of your everyday staple diet so that its easy to follow it throughout life! Do not drastically change the food items which you consume daily.

9. Eat only natural sugar: in the form of fruits or honey. This way you can avoid sugar and sugar containing items like cakes and cookies.

B. Tips regarding exercising:

1. Regular Exercise is a must. Brisk Walking for 30-45 minutes should suffice for most of us.

2. Earn your TV time! If you exercise for half hour, you get to watch TV for half hour!

That’s one of the best advice I give to my patients. NO EXERCISE = NO TV!

3.  Any time of the day is good enough for exercise! If you miss your morning walk, try to do it in the evenings.

4. Walk, walk, Walk! Walk the stairs, walk in your office, walk to the supermarket, walk in your neighbourhood. Walk even when you are working! Walk whenever you see a opportunity. This can help in burning calories even if its for a few minutes!

5. DO NOT CONCENTRATE ON LOSING WEIGHT OR A MAGIC NUMBER! Living a Healthy life is more important than procrastinating on why the weight is not reducing!

Give up worrying about your weight. Just concentrate on Living and Eating Healthy. The rest will follow in due course. Even if it does not, you have the sense of accomplishment of following a Healthy Lifestyle!

So, Eat Healthy and Walk Healthy for Life!

From Walking to Running!

Its necessary you read my earlier post: “Start Walking: How do I do it?”

In this post we will discuss about How to graduate from walking for 30 min to running for 30 minutes.

The American Heart Association recommends at least 30-45 minutes of exercise of moderate intensity. The goal is to increase your heart rate to at least 80% of your maximum heart rate (MHR). The MHR is calculated from the formula 220-age.

Exercises which will increase your heart rate are ones which are carried at moderate intensity. These include jogging, running, cycling, swimming and so forth.

After reading the article on  “Start Walking: How do I do it?”, I am taking for granted that you will be in a position to carry out brisk walking for 30 minutes at a stretch.


To run you need to do brisk walking without feeling breathless. This is necessary as going to running directly when one cannot walk could be dangerous. Running is to be avoided if you are extremely obese. Please don’t overtrain and injure yourself. During any stage of the exercise, if you feel any pain in your joints (especially the knees), its advisable to stop running. Seek medical advice if the pain persists.

Here are some general guidelines to graduate to Running:

1. Always start with some stretching exercises to relax your leg muscles.

2. Start walking at a comfortable pace for at least 10-15 minutes.

3. Now to proceed to running continuously for 30 minutes. This can be gradual and you need not rush into it. I would recommend the following to achieve this:

Lets break the 30 minutes into 5 minute intervals:

Weeks 1 and 2:  Run for 1 minute, Walk for 4 minutes, Repeat this for 30 minutes.

Weeks 3 and 4: Run for 2 minutes, Walk for 3 minutes, Repeat this for 30 minutes.

Weeks 5 and 6: Run for 3 minutes, Walk for 2 minutes, Repeat this for 30 minutes.

Weeks 7 and 8. Run for 4 minutes, Walk for 1 minute, Repeat this for 30 minutes.

Weeks 9 and 10: Run for 5 minutes, with no walk intervals, (one can still continue to have 30-60 seconds walking breaks if one wishes). That’s continuous running for 30 minutes! Congratulations! Sounds Easy!

Please remember: The 2 week options are not compulsory. One can continue with a particular week plan as long as you are comfortable (say for 4 weeks). You need to be comfortable and not have any injuries during the run. If you have any pain, stop running. Rest for few days till the pain goes away and continue only walking during that time.

So in just 10 weeks you will be able to go from  Walking to Running for 30 minutes a day!

4. The pace of running is entirely up to you. Do not sprint and invite injuries. Let it be very slow at the start. Maintain a pace wherein you are in a position to carry a conversation with a friend/ running partner comfortably without being out of breath. Slow running is better and can be continued through out life rather than fast running which may invite injuries and cause you to give it up.

5. Do a cool-down walk of 15 minutes following the run.

6. The important thing is to enjoy it! During any stage, if you feel tired or breathless, please go back to walking. Its also safer to consult your doctor if you have never exercised before.

Sounds Easy! I hope it helps! Running not only improves physical health but also give immense mental satisfaction and a sense of accomplishment. So Savour every moment of the run and the healthy lifestyle! Good Luck!

Start Walking: How do I do it?

The American Heart Association recommends at least 30-45 minutes of exercise of moderate intensity. The goal is to increase your heart rate to at least 80% of your maximum heart rate (MHR). The MHR is calculated from the formula 220-age.

So, how do you start regular walking if you have never walked before?

Exercises like running can be very bad for the joints if one is overweight and also not trained well. Swimming is one of the best exercises for the overweight, however not everyone has access to swimming pools.

So the easiest one to carry one and perform is WALKING!

Walking can be performed at any time or place and even when you are travelling!

But what do you do if you have never exercised before?

Take it easy! You can do it! Read ahead!

Here are some general guidelines:

1. Start walking at a leisurely pace for at least 10-15 minutes in a day.

In case you feel tired or breathless, slow down.  Its recommended to start any exercise gradually so that you minimize injuries. Do not overtrain.

If you have never walked before, walk for a minute and then take a break for 4 minutes. Repeat this for 30 minutes.

2. One may experience muscle cramps or joint pain in the initial few days if one has never exercised before. Do not get disheartened! Take it easy if you experience some! Apply some local ointment or take hot fomentation (with a hot water bag/ or a hot shower). Do some stretching exercise to relax your muscles. The aches and pains usually disappear in one or two weeks time.

3. Continue Walk and Rest repeats till you can do it for at least 30 minutes.

4. Now to proceed to walking continuously for 30 minutes. This can be gradual and you need not rush into it. I would recommend the following to achieve this:

Lets break the 30 minutes into 5 minute intervals:

Week 1:  Walk for 1 minute, Rest for 4 minutes, Repeat this for 30 minutes.

Week 2: Walk for 2 minutes, Rest for 3 minutes, Repeat this for 30 minutes.

Week 3: Walk for 3 minutes, Rest for 2 minutes, Repeat this for 30 minutes.

Week 4. Walk for 4 minutes, Rest for 1 minute, Repeat this for 30 minutes.

Week 5: Walk for 5 minutes, with no rest intervals, That’s continuous walking for 30 minutes! Congratulations! Sounds Easy!

So in just 5 weeks you will be able to go from No Walking to Walking for 30 minutes a day!

5. The important thing is to continue it for life and not give it up after few days.

Sounds Easy! I hope Everyone of us carries on Walking! Walking for Life!

Walk, walk, walk!

Walk, walk, walk!

That’s the best advice I give to my patients.

Healthy lifestyle = healthy heart!

What’s the best exercise for the heart?

Its Aerobic exercise which the heart needs. Aerobic exercises increases the heart rate and thereby improve cardiac reserve.

Which are the Aerobic Exercises I can do?

Exercises which result in an increase in heart rate are good. These include:

Brisk Walking

Running/ Jogging



How does one know that the heart rate increases on a particular exercise?

One can feel his pulse or also feel the heart beats in the form of palpitations. Nowadays, one can buy a heart rate monitor which can be applied on the chest or on the arm.

Does slow walking help?

Yes it does help to a certain extent. However it may not result in good increase in heart rate if the pace of walking is slow.

How much should the heart rate increase to?

The heart rate should increase to a 80 to 85% of your maximum heart rate. One can calculate his maximum heart rate by the formula 220-age.

Maximum Heart Rate (MHR) = 220 – age of the individual

How long should this heart rate increase persist?

To derive maximum benefit, one should maintain the momentum of exercise for at least 15-20 minutes.

What health benefits does aerobic exercise offer?

Reduces BP

Reduces Cholesterol

Reduces sugar

Reduces weight

Reduces chances of heart attacks

Improves cardiac reserve

Improves mood

Improves joint mobility and reduces arthritis

Strengthens bones and joints

Increases ones confidence

Also, its doesn’t cost a thing!

Which is the best exercise?

Brisk walking happens to be the best as it can be done by individuals of all age groups. It can be done even if you are travelling out of town. It can be done any time of the day. and doesn’t cost a penny! Also its less stressful on the joints compared to running which can cause knee pain. If one has access to swimming pool, swimming is good for individuals with arthritis issues.

Whats the current recommendation for Exercise?

The American Heart Association recommends at least 30-45 minutes of exercise for all individuals for a minimum of 5 days in a week.

What about yoga?

Yoga/ Asanas are static postures and so do nothing to increase heart rate (and thereby the cardiac reserve). Pranayam and Yogasanas relaxes the body and mind and stretches the joints and muscles. Thereby, they provide a relaxing effect and reduce heart rate and blood pressure. They also help in reducing anxiety.

What about Surya-namaskars?

Surya-namaskars if done at a fast pace can increase heart rate and improve cardiac reserve. However for most of us its easier to go out walking than do surya-namaskars. Also the heart rate increase with surya-namaskars may not be to the extent as with other aerobic exercises.

What about mental health?

Relaxing techniques like pranayam, breathing techniques and even praying can relax one’s mind and provide much needed rest to the mind. Good sleep and adequate lesiure time is also necessary.