Diastolic Heart Failure - Dr Vivek Baliga, Baliga Diagnostics

In this brief presentation, Dr Vivek Baliga discusses the basics of diastolic dysfunction seen in clinical practice.

Dr Vivek Baliga - Diastolic heart failure - A complete overview from Dr Vivek Baliga

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For patient health articles, visit HeartSense Website

 

Alkaline Foods to Prevent Cancer, Obesity & Heart Disease by Dr Vivek Baliga

With time, we all get older and as we get older, we need to take care of our health more often. As children, we used to keep our bodies active by playing most of the time. But as we grow old, a lot of responsibilities take a toll on our activeness which leads to a lot of diseases such as obesity and other chronic heart diseases. This will be very problematic in the long run and as older adults, chances are that we will have severe diseases that began with bad diet and no activity. You can prevent this, yes that is possible. You must eat food items that are rich in alkaline. Alkaline is known to prevent diseases like cancer, obesity and heart diseases. Dr Vivek Baliga lists different foods that are alkaline in nature and that will help you in maintaining your health well:

1. Spinach

Spinach is something that our mothers have asked us to eat ever since we were kids and most of us disliked it. But did you know that spinach can abolish free radicals? Yes! Not only that, spinach can also improve your memory and keep your heart strong. This is because spinach is rich in antioxidants that can stimulate your brain functions. It is extremely healthy and has a lot of benefits in the long run.

2. Lemons

Rich in Vitamins E, A, C, B6, lemons have a lot of important minerals like zinc, calcium, potassium etc. The lemon juice is known to minimize the risk of a stroke. It is also a cure for kidney stones and helps you fight cancer. This is why most people prefer drinking lemon juice or lemonade during the summers. It not only helps you in freshening up, but it also helps you in a lot of ways by boosting your health.

3. Quinoa

Quinoa is the one food dish that is known to control cholesterol and blood sugar level. Experts have suggested that quinoa is right is proteins and when it is compared to other grains, it has a lot more fiber. Today, a lot of nutritionists and dieticians will suggest you to switch to quinoa to maintain your health and to avoid problems in the long run. This is mainly because, quinoa is rich in manganese, magnesium, riboflavin, lysine and iron.

4. Buckwheat

Ordinary wheat may not be fattening but it still does not help you improve your health. Buckwheat on the other hand, can help you in fighting diseases like diabetes and other chronic diseases related to heart. It also happens to be the single most essential food to eat to get the right amount of nutrients such as vitamins, iron and proteins.
 
5. Bananas

Bananas are not only most people’s comfort food, but they should also be something that you incorporate in your regular meals. They help you lose weight. Of course, the weight loss will not be a dramatic transformation but it is sure to happen steadily. Additionally, they are rich in nutrients like potassium, manganese, B vitamins and fiber.

Dr Vivek Baliga reviews that consumption of alkaline foods can be highly beneficial for your health. So, you must incorporate these foods into your daily diets.

Statin Therapy Reduces Future Risk of Lower-Limb Amputation in Patients With Diabetes and Peripheral Artery Disease

Lowering cholesterol has been important for a while now. It not just prevents heart disease, it can also lower your stroke risk.

There are those that use supplements as a way to lower cholesterol, but statins remain the gold standard in management.

Preamble: Although there is evidence to support the beneficial effects of statins on major cardiovascular events, few studies address the protective effect of statins on limb outcome.

Hsu CY et al. aimed to investigate whether the use of statin is associated with a risk reduction in lower extremity amputation in type 2 diabetes mellitus (DM) patients with peripheral arterial

disease (PAD).

Design: Observational cohort study.

Setting: A nationwide DM database in Taiwan from 2000 to 2011.

Patients: A total of 69,332 patients aged ≥ 20 years with DM and PAD were identified.

Intervention: Patients were divided into three groups: 11,409 patients were statin users, 4430 patients used non-statin lipid-lowering agents, and 53,493 patients were nonusers.

Main Outcome Measures: The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality.

Results:

·    Compared with nonusers, statin users were associated with lower risks of lower-extremity amputation [adjusted hazard ration (aHR), 0.75; 95% confidence interval (CI), 0.62 to 0.90], in hospital cardiovascular death(aHR, 0.78; 95% CI, 0.69 to 0.87), and all-cause mortality (aHR, 0.73; 95% CI, 0.69 to 0.77).

·    In the propensity score matching analysis, the effect of statin on the risk of lower-extremity amputation was consistent. Only statin users were associated with the risk reduction of lower-extremities amputation (HR, 0.77; 95% CI, 0.61 to 0.97) and cardiovascular death (HR, 0.78; 95% CI, 0.68 to 0.89) when taking competing risk of death into consideration.

The authors concluded that compared with statin nonusers who were never treated with lipid-lowering drugs, statin users had a lower risk of lower-extremity amputation and cardiovascular death in patients with DM and PAD.

Dr. Vivek Baliga, Baliga Diagnostics, Bangalore

An accomplished medical professional, Vivek Baliga began his education at Sri Aurobindo Memorial School, located in Bangalore, India. Excelling in and out of the classroom, Dr. Baliga participated in the school's organized basketball team. Following grade school, he matriculated at Bangalore's National College Jayanagar.

Concentrating on pre-university science courses, Dr. Baliga continued playing sports and earned recognition as a badminton champion for his college in 1994.

After two years, Vivek Baliga successfully completed his studies and enrolled in Manipal Academy of Higher Education in 1995. Anticipating a career in medicine, Dr. Baliga pursued his Bachelor of Medicine, Bachelor of Surgery (MBBS) degree and graduated in 2000. 

During his time at the academy, he played on the basketball team, which clinched championships in 1999 and 2000. Today, he continues to play from time to time as a hobby. Loves the 3 points still!!!

Dr. Baliga continued to expand his education by working toward a doctorate with a focus on cardiovascular research. He is currently a member of the Royal College of Physicians and of the Indian Academy of Echocardiography, of which he is the secretary of the Karnataka Chapter.

 Since beginning his career, Vivek Baliga has published several articles in various medical journals. In 2009, he co-authored an article for Prescriber, a periodical devoted to prescribing and medicine management. His article concerned advice for managing acute coronary syndrome. 

His article on Diabetes and heart failure was the most downloaded article on Sage publications two years in a row.

Dr. Baliga also co-penned a piece for the American Heart Association regarding the effect of insulin receptor levels and other factors contributing to insulin sensitivity on the endothelial cells, a thin layer of cells found on the interior of certain vessels.

 Vivek Baliga also contributes to the medical community as a philanthropist. In 2011, he took part in the 10-kilometer Bupa Great Manchester Run, accepting donations for the Desk & Chair Foundation. He was also part of a team of doctors in Mangalore which provided education to teachers and children about malaria prevention.

Dr Vivek Baliga is  the author of a number of different articles across different medical specialties. He is an expert author on ezine articles, has published numerous article for his newsletter Sowkhya Magazine and has published articles in peer reviewed journals as well.

In addition to authoring number of articles online, Dr Vivek is also an expert author on Medlife.com. His articles are published on their blog and also in their patient magazine. You can also finding him tweeting health tips here.

A Mango A Day Keeps The Doctor Away - Dr Vivek Baliga Writes

Mango season is upon us, and the sweet fruit is pretty much on every one’s mind.

But mangoes are just not delicious to taste; they also have many additional health benefits. Let’s take a brief look at these and understand why they really are the ‘king of fruits’!

Mangoes are rich in anti-oxidant compounds.

These are powerful fighters of free radicals that are responsible for skin damage and cancer. It is believed that eating mangoes can reduce your risk of colon cancer and prostate cancers.

These compounds include quercetin, isoquercitrin, astragalin, fisetin, gallic acid and methylgallat, as well as the many enzymes.

The high level of fiber in mangoes can help combat high cholesterol levels. They can lower bad LDL cholesterol levels.

Mangoes are also rich in vitamin A, which is essential for your eyes to remain healthy. In fact, one cup of sliced mango provides you with 25% of the required amount of vitamin A you need daily.

We often advice patients with diabetes to avoid mangoes, but if your blood sugar levels are well controlled, it is okay to have 3 or 4 small pieces of this fruit. Around 15 grams is okay. Mango also contains vitamin C that can boost immunity and fight infections.

Enjoy in moderation, but make sure you do!

For more articles on health by Dr Vivek Baliga, visit here.

Was Popeye Right About Spinach? Dr Vivek Baliga Writes

In this article, Dr Vivek Baliga writes about Spinach and how it can help you.

For those of you who are cartoon enthusiasts (like me!), I always waited for Popeye the sailor man to munch down on a can of spinach, suddenly develop huge biceps (in seconds) and beat down the villain to save his girlfriend Olive.

Well, spinach seems to have quite a few health benefits, and indeed Popeye was right to scoff down on this time and again. Firstly, spinach is a dark green leafy vegetable, and is low in calories. Previously referred to as the ‘Spanish Vegetable’, spinach is now widely used in fresh salads, soups and even in our Indian curries.

Spinach is rich in niacin and zinc as well as protein, fiber, vitamins A, C, E and K, thiamin, vitamin B6, folate, calcium, iron, magnesium, phosphorus, potassium, copper, and manganese. In other word, it’s loaded with good things for every part of your body! It is packed with flavonoids which has powerful anti-oxidant properties. It can fight harmful free radicals that are generated through metabolic processes in the body, thus protecting the heart and the other vital organs.

Spinach is rich in folate which can help you maintain a healthy heart. Magnesium can help control your blood pressure and keep it low. The iron content can raise your haemoglobin and is a good natural treatment for anemia. Spinach also improves your memory power and brain function. Make you have some every day! 

For more information, visit http://heartsense.in. 

Dr Vivek Baliga Review

Over the years, Dr Vivek Baliga has been writing articles for his blog HeartSense and Making Sense of Diabetes.

With a keen interest in academics and education, Dr Vivek, a consultant in Internal medicine and cardiovascular sciences at Baliga Diagnostics, Bangalore, has been involved in writing patient information articles for over 8 years. He has been a top article writer on Fiverr.com and has ghost written a number of articles for clients over the world.

His interest is in the management and treatment of diabetes and its cardiovascular complications, particularly heart failure. He is currently pursuing a degree in lipid management from Middlesex university, UK.

You can view the articles on Making Sense Of Diabetes here.

Evidence For Dyslipidemia - Dr Vivek Baliga

Dr Vivek Baliga of Baliga Diagnostics discusses an evidence based approach for the management of dyslipidemia.

Dyslipidemia management an evidence based approach from Dr Vivek Baliga

Find Dr Baliga online here.   

Managing Diabetes When Travelling - Dr Vivek Baliga Article

 Dr Vivek Baliga, Consultant Internal Medicine writes this article on managing diabetes when traveling. This is only an excerpt. If you wish to read more, click here.

Managing diabetes can be a daunting task, especially when you are traveling. When should I take my insulin, what should I eat on a long journey and can I carry my injections on a flight are some of the commonly asked questions.

The truth is that it only takes a few simple measures to keep your blood sugar levels under control. Be it travel by car or by flight, the general principles remain the same.

Read here if you wish to learn more about managing diabetes when traveling.

 For more articles by Dr Vivek Baliga, visit http://heartsense.in/author/dr-vivek-baliga-b/

Organ Donation - Be A Part Of The FORT Program - Dr Vivek Baliga article

In this presentation, Dr Vivek Baliga discusses the reasons why you should list yourself for organ donation, and why you need to be a part of the FORT program.

Dr Vivek Baliga - Organ Donation And The FORT Program from Dr Vivek Baliga

You can read this article online by visiting  http://heartsense.in/organ-donation-fort-program/

Connect with Dr Vivek Baliga on LinkedIn -  https://www.linkedin.com/in/dr-vivek-baliga-7b59b0125

For more articles on health by Dr Vivek Baliga, click here

Association of 3 Different Antihypertensive Medications With Hip and Pelvic Fracture Risk in Older Adults - Review Dr Vivek Baliga

Dr Vivek Baliga, Consultant at Baliga Diagnostics discusses a recent paper.

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OBJECTIVE : To examine whether the use of thiazide diuretics for the treatment of hypertension is associated with reduced fracture risk compared with ACEI and CCB.

Methods:

• The study examined hip and pelvic fracture hospitalizations in ALLHAT participants (> 65 years & from USA only) randomized to chlorthalidone (CH), amlodipine besylate, or lisinopril from 1994 to 1998;
  
• The mean study follow-up was 4.9 years.
  
• Post-trial extended follow-up was conducted till 2006, using passive surveillance via national databases.
  
• MAIN OUTCOMES AND MEASURES Hip and pelvic fracture hospitalizations

 RESULTS:

• Total 22 180 participants (mean age, 70.4  years) were followed for up to 8 years (mean: 4.9  years) during masked therapy.
  
• After trial completion, 16 622 participants  were available were followed for up to 5 additional years (mean total follow-up: 7.8 years). 
  
• Participants in CH group had significantly lower risk of fracture by 21%  vs (amlodipine/lisinopril) on adjusted analyses [0.82 Vs 1.17 per 100 Person years ([HR], 0.79; P = 0.04).
  
• Risk of fracture was significantly lower by 25% in CH group vs lisinopril group (HR, 0.75; P = .04)
  
• No significantly difference in risk of fracture in CH Vs amlodipine group (HR, 0.82; ; P = .17).
• In extended follow-up, cumulative incidence of fractures was nonsignificantly lower in CH group vs (lisinopril or amlodipine) (HR, 0.87; P = .10) and vs each medication separately. 

CONCLUSION:

Elderly hypertensive patients on chlorthalidone (CH) therapy has lower risk of pelvic/hip fracture than those on ACE inhibitors in ALLHAT trial.   

Dr Vivek Baliga - PRECISION: Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis

Dr Vivek Baliga, Consultant at Baliga Diagnostics discusses a recent paper.

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OBJECTIVE: To assess cardiovascular, gastrointestinal, renal, and other outcomes with moderate dose celecoxib Vs ibuprofen and Naproxen in arthritis patients with high CV risk

METHODS:

• Patients who required NSAIDs for osteoarthritis or rheumatoid arthritis and were at increased CV risk were randomised to receive celecoxib, ibuprofen, or naproxen.
  
• Patients initially received celecoxib (100 mg BD), ibuprofen (600 mg TDS), or naproxen (375 mg BD) with matching placebo.
  
• Dosage can be increased upto: celecoxib -200 mg BD,  Ibuprofen 800 mg TDS, or  naproxen 500 mg BD for the treatment of symptoms
• Esomeprazole (20 to 40 mg) was provided to all patients for gastric protection.
• Low-dose aspirin (≤325 mg daily) was permitted to patients if required.
  
• Primary Composite Outcome :  Cardiovascular death (including hemorrhagic death), nonfatal myocardial infarction, or nonfatal stroke
• Analysis was done on both ITT (intention to treat) and on treatment population
  

Results

• Total 24081 patients were initially randomized,
  
• Baseline Characters:Mean Age 63 years, 23% patients had established CVD, 90% had osteoarthritis, 10% had rheumatoid arthritis
• Mean treatment duration: 20.3 months; Mean followup period of 34.1 months.
• During the trial, 68.8% of the patients stopped taking the study drug, and 27.4% of the patients discontinued follow-up
  
• No difference in primary end point between 3 drugs. Celecoxib was non-inferior to naproxen and ibuprofen in both ITT and on treatment analysis  (as shown in figure)

Conclusion:
At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety

Link to the article
http://www.nejm.org/doi/full/10.1056/NEJMoa1611593

Dr Vivek Baliga - First Aid For Toothache

Tooth ache can be a nuisance. Here are some first aid tips from Dr Vivek Baliga to manage tooth ache at home.

Our oral cavity is a breeding ground for bacteria. Bacteria can increase the production of acid within the mouth, causing damage to the teeth and tooth decay. Tooth decay is a common cause of tooth ache.

Tooth ache usually starts slowly and can get worse over time. Patients describe it as a ‘throbbing’ or ‘aching’ pain or discomfort that is often worse at night. It may be a constant pain or one that comes and goes. The teeth become sensitive to hot and cold, meaning that eating or drinking hot or cold foods and fluids can make the pain worse.

Here are some simple tips to manage toothache.

1. Rinse the mouth with clean warm water. This can get rid of any large food particles that are stuck in between the teeth.

2. Clean the teeth and gums with dental floss to remove any small pieces of food stuck in the teeth.

3. Apply a numbing gel that contains a local anaesthetic to the area that is painful. Always seek medical advice before using any medication. Some local anaesthetic agents are harmful for children below the ages of 2 years.

4. Take painkillers if required. Simple paracetamol and ibuprofen can be sufficient.

Despite the above, tooth ache can continue sometimes. This could indicate more severe tooth damage than you thought or could be due to an underlying infection. In such situations, seeing a dentist as soon as possible is advised.

When to see a dentist  Persistent pain despite painkillers. Difficulty chewing and swallowing food. A high fever accompanies the toothache (could indicate a dental abscess). ·         The gums are swollen and red and there is pus formation. ·         If the patient develops difficulty breathing.

After-care

Once treated, make sure you maintain proper dental hygiene by flossing the teeth before brushing. Brush teeth twice a day with a good quality fluoridated toothpaste. Avoid smoking and chewing tobacco.

A word of caution

In older patients who have risk factors for heart disease, a toothache can sometimes be an indication of angina or a heart attack. Often patients have accompanying symptoms such as chest pain as well, and the pain is no worse on chewing and swallowing. If you have any concerns, talk to your doctor. 

Dr Vivek Baliga Presentation - Pulmonary Embolism

Dr Vivek Baliga, Consultant at Baliga Diagnostics discusses pulmonary embolism and how it should be managed in clinical practice.

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Pulmonary embolism - Diagnosis and management from Dr Vivek Baliga

Dr Vivek Baliga Health Check Before Taking Up Running

We recently conducted a blood pressure camp at a nearby gym, where all members who walked through the door had their blood pressure checked.

Of the 25 members we screened in 2 hours, we detected high blood pressure in 3 of them! One had a blood pressure of 220/130 mmHg (normal is around 120/80 mmHg), and he was just 37 years old! He had been working out without knowing he had high blood pressure, and it is likely that if you continued without treatment that he would be at risk of a heart attack, stroke or kidney disease.

Why get a medical check up?

The problem with illnesses such as high blood pressure and heart disease is that it can be ‘silent’. People are unaware they have a problem until they have undergone a health check-up. 

You may have heard of cases where young people have died suddenly when out for a walk or even when sitting at home. Many a time, these tragedies are due to undiagnosed heart disease which could have been detected if the person had undergone a medical check up.

What to get done

The important tests that must be done in all people looking to take up running as a hobby (or professionally) must include a blood test, electrocardiogram, echocardiogram and an exercise treadmill test.

Blood tests can help determine if an individual has low haemoglobin, high blood sugar and/or high lipids. All these can be risk factors for heart disease and can be easily treated though lifestyle modification and medicines.

An electrocardiogram (or ECG) is a test that looks at the electrical activity of the heart. An abnormality in the conduction of electricity is clearly seen on the ECG and this may need treatment. Rare cases that need immediate treatment have been picked up on an ECG and the information put together with other tests has helped reach a diagnosis. In some cases, the ECG can be normal even there is an underlying problem, though this is rare.

An echocardiogram is a specialised test where ultrasound waves are used to visualise the heart on a machine. The test will provide information on the structure of the heart muscle, the state of the valve and how strong the heart is pumping (called ejection fraction). Causes of sudden cardiac death such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC) can be detected through this scan. Narrowing of the heart valves and abnormalities in their function such as leaks can also be detected easily. 

You can read about these conditions on the website www.heartsense.in.

An exercise treadmill test is a very useful test that can help determine how the heart performs when the person is exercising. The normal response is for the heart rate and blood pressure to go up and for the ECG to remain in normal limits. Exercise tests are doctor supervised and the patients are pushed till the heart rate reaches a particular value (called target heart rate, which is 220-age of the individual). Some tests are continued beyond the target heart rate, but this is rarely necessary.

The treadmill test can help determine the following – 

1. Is there any abnormality in the way the heart conducts electricity? This can be seen with the way the waves look, the regularity of the heart beating and the presence of extra beats or abnormal rhythms.

2. Is there any problem with the circulation of blood to the heart? This can be determined if there are changes in particular segments of the ECG on exercise or at rest.

If any abnormality is found, your doctor will let you know if you need any further investigations. Some patients may be advised not to exercise until all additional tests have been done.

While most patients who undergo these tests have normal results, it is not uncommon to pick up the odd case where the tests are positive. These patients have gone on to have either angioplasty, bypass surgery or have commenced medication. Lifestyle changes form part and parcel of these treatments as well, and must be followed strictly.

‘It is better to be safe than sorry’

 

You may have heard this before. It cannot be any further from the truth when it comes to running and your heart. These tests are simple to perform and take no more than a couple hours of your time. Numerous centres now offer these tests at a good price, with only a handful running specialist packages. 

Now that you have read this tip, make time to see your doctor and talk to them about getting the tests arranged. 

For more articles by Dr Vivek Baliga, click here.

Dr Vivek Baliga Presenation - Diastolic heart failure

In this presentation, Dr Vivek Baliga discusses a common cardiac problem encountered in clinical practice - Diastolic heart failure, a term now replaced by Heart Failure with Preserved ejection fraction.

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Dr Vivek Baliga - Diastolic heart failure - A complete overview from Dr Vivek Baliga

Dr Vivek Baliga - Getting Inspired For Running

Dr Vivek Baliga - How To Get Inspired For Running

Ask people who do not exercise every day what they think about running, and chances are they will retaliate with a comment ‘isn’t running boring?’

As a runner, it is possible to get easily offended by this comment; some may just sweep it under the rug and move on.

The fact of the matter is this – running is one of the most enjoyable sports there is. Furthermore, those who think that there is no fun in running may not realise that running forms the ‘building block’ of most sports. Cricketers run in between wickets and to bowl, footballers run, tennis players run; almost every ground sport has some form of running in it.

We have already talked about the ‘runner’s high’ in a previous section. This high aside, many runners find that running clears their head of stress and worries they may have had in the day. In the west, it is not uncommon to find people with busy jobs getting a run in even late in the night just to clear their head. 

At times, when running, it is not unusual to hit a ‘plateau’ – a phase where you just don’t feel like going for a run. This plateau can put a big dent in your running routine; many have even given up running due to this.

 

There is no shame in hitting a plateau – it is not a testament in any sense to being lazy or short of motivation. Every one hits it at some point in their running routine. It’s all about trying to come out of that phase and move on to the next level of running.

How can you achieve this? Well, get inspired! Here are some simple ways.

1

1. Remember why you took up running in the first place. It might have been to become fit because you were breathless when walking up stairs or because you looked at yourself in the mirror one day and did not like what you saw. 
2. Read an inspiring story – There are many runners who have been on a long and tedious journey to be a successful runner. Along the way, they have encountered many problems which most runners would anyway. Read about these and use their recommended strategies to restore your focus on your goals.
3. Set easy goals – Setting too many can confuse things for you. Decide on your goal and work towards it every day.
4. Play your favourite tunes before you run – If you love music, then playing tunes that inspire you are great before you head out for your run. Music can pump you up and get you prepared for your run.
5. Talk to a friend – There are friends who motivate, and these friends are invaluable when it comes to running. If you feel a lack of motivation, ask your friend or running buddy to give you a pep talk. All it takes sometimes is a little push to get you going again.
6. Attend local fun runs – If you are bored on a weekend and seek inspiration to run, just head out to any running events that may be going on in your neighborhood and cheer the runners. You don’t even have to run – just watching them can sometimes be inspiration enough. You will see people of different ages running, and these are an invaluable source of inspiration.
7. Reward yourself – If you have completed a run that you thought you could not do, then most certainly reward yourself once in a while. This could be in the form of eating a small portion of your favourite food, or enjoying a healthy dinner out with friends. We don’t recommend you buy yourself a Ferrari though. 
8. Have a blog – Having a running blog can be a great way to inspire yourself. When you don’t feel like going out for a run, just go through your own blog or the blog of others. Your mood reflects in your blog posts, and you will likely be reminded of how you felt when you ran and then came home to blog about it. 

Creating a blog is simple – you can do so on Blogger or Tumblr. Comments and congratulations from friends and even complete strangers can be a wonderful source of inspiration.