Pioneer in advanced Cardiac Arrhythmia services and key person in Interventional Cardiology, Dr (Prof) Mohan Nair, Chairman, Cardiac Sciences, Saket City Hospital (SCH). In conversation with Shahid Akhter, ENN

We are prone to heart disease for various reasons, including genetic. Is this a myth or a frightening reality ?
Indians are genetically more prone to developing cardiovascular problems than any other ethnic group in the world. It is exceptionally prent in the Indian sub-continent and is upto four times more common than some other regions of the world. Scientists are researching to find out a precise genetic mutation that affects Asian Indians. In the West, heart attacks are usually reported in the elderly ( 60-70s age group) but in India, it happens at least a decade early thus resulting in an alarmingly growing number of young people are being affected.

Driven by a Credo You First, Saket City Hospital is a fast emerging healthcare center that promises highest level of quality amidst technology that is truly world-class and futuristic.Today at the Saket City Hospital, we have the technology to diagnose or rule out life threatening causes of acute chest pain, in not more than three minutes. The urgent need in case of a heart attack is to restore the blood flow in the culprit region, as quickly as possible

How popular is preventive cardiology? How is the influx of people who turn up for routine check ups?
There is a lot of emphasis on utive health check and many good plans and packages are offered but today such check ups are pass©. Random screening may lead to unwanted tests and treatments. At times it leads to over diagnosis which tends to turn healthy people into patients. The usefulness of such preventive tests for healthy people is controversial and debated in the West. In the US, there is a tendency to curb them and so called annual physical tests are increasingly falling out of favour with most of the doctors. Instead, what we offer is a focused check up which is based on preventive services and interventions that are patient specific and have proven effectiveness. For example, after reviewing the patients health risk and accessing various parameters such as age, body weight, family history of heart disease, kidney damage, diabetes, cervical cancer etc; precise medical tests are recommended. If you have a family history of heart disease, we would be concerned about high cholesterol, high blood pressure, diabetes, smoking and other cardiovascular risks, and will run you through a tailored preventive cardiology checkup that can be of benefit to you and other members of your family.

Besides the routine angioplasties and bypass or valve surgeries, do you have any advanced heart failure clinic equipped with high end devices like Ventricular Assist Device (VAD) ?
Heart failure clinic is in the pipeline and shortly we will be having a very fast track approach in this direction. In case of heart attack, time is a crucial player. The attack is triggered when blood and oxygen flow to the heart becomes totally interrupted by blockage in any of the coronary arteries. Disruption of oxygen prompts chest pain, pressure or shortness of breath, nausea and other symptoms. VAD is not as of now available in India. It is a mechanical device or pump used to support heart function to maintain the blood flow. It helps during or after surgery, until the heart recovers and can handle the blood flow on its own. It also comes to the rescue when one is awaiting heart transplant. VAD is very likely to be introduced in near future.

What technological advancements have been introduced lately at Cardiac Care Centre, SCH and what sets it apart?
A top-notch cardiac department is not just about a pool of best cardiologists but also a high end cath lab and the best of technological support. It is very important for the cardiologists to get accurate images of the heart. We are equipped with Philips Ingenia 3 Tesla MRI scanner with 4D Multi Transmit Technology. Besides patient comfort and detailed imaging, it provides perfusion and non contrast peripheral angiography. The other technological marvel is the dual energy, ultra fast CT scanner from Philips iCT 128 (256 slice/ sec). Besides brief scan time and a great detail, it comes with lowest possible radiation dose. The software automatically selects the lowest possible radiation. Stent Boost is another Philips software that helps in fluoroscopy based assessment of stent scaffolding. In the emergency, again keeping the importance of timely intervention, as soon as a the patient has had his ECG the results are sent to the concerned cardiologists smart phone instantly. We offer a full range of cardiac services, with our state-of-the-art noninvasive laboratory performing 3D echocardiography, Stress echocardiography; Transesophageal echocardiography. The department has good track record of performing primary angioplasty & stenting in acute heart attack patients. Our lab also has latest 3D mapping technology to offer treatment for complex arrhythmias and is a designated center of excellence in this field. Heart Center also includes the Cardio-Thoracic & Vascular surgery division that caters to the entire spectrum of Cardiac surgical procedures.

What new ways or breakthroughs have emerged to save the heart ? Have you adopted any such new technique?
Aortic valves are surgically implanted but now in the US and Europe, these valves are being replaced without open heart surgery. It is delivered via a catheter, where the stent opens and pushes the old valve out. These valves (Core Valve/ Edward Sapien Valve), are ideal for patients who need surgery but are at high operative risk. These are expensive, FDA approved but not yet sanctioned by Drugs Controller General of India (DCGI). These valves of the future will soon be appearing in India and our junior colleaues are already undergoing Transcatheter Aortic Valve Implantation(TAVI) training in Belgium, US, Canada and France. Absorbable Stents is another innovative device to treat coronary artery disease. It takes around two years to dissolve and there is no metal left behind. It is three times as expensive as the best available medicated stents; therefore we will have them on our shelf but its not a priority.

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