( By Dr. Krishna Murari Modi )

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3-Affairs of the Heart

Heart pumps blood to all parts of the body, blood carries oxygen to the brain and other parts, as long as the heart pumps blood, the body gets the oxygen it needs. If the heart machine stops, the oxygen is cut off and the person will die unless a special artificial devices is used to stimulate the heart.

Each side of the heart performs a different pumping job. The right side takes blood from the body and turns it to the body. blood entering the right side of the heart contains carbon dioxide a waste product. All blood entering the right side of the heart goes to the lungs before it reaches the left side of the heart. In the lungs the carbon dioxide is removed and oxygen is added to the blood. Blood that flows from the left side of the heart contains fresh oxygen. The oxygen is used in the body cells to produce energy. Without oxygen the body cells stop working. Sometimes the body needs much oxygen. At other time, it requires little.

An adult heart normally beats about 70 times a minutes, but the rate changes automatically to provide as much or as little oxygen as the body needs. The body needs a log of fuel for strenuous exercise as swimming or ice skating. For this reason, the heart beats rapidly when a person swim or skates. It is rushing more oxygen to the body by speeding the flow of blood.

If the person stops exercising, the heart gradually slow down. The heart beats faster when a person is angry, afraid or excited. It is rushing more oxygen to the muscles to prepare a person for fighting or for running away. During pregnancy, a woman’s heart takes car not only of her own needs, but also of those the unborn body baby; her heart increases its output by half to three fourths more than normal.

Some of the heart disease: Atherosclerosis is a condition when deposits of fatty material and calcium narrow the arteries and roughen their normally smooth lining. These deposits are called plaques, they cause cells in the artery walls to break down. Substances from the ruptured cells irritate the nearby tissues causing scars to form. The artery wall becomes hard, rough and narrow. The coronary arteries which nourish the heart muscle itself are more frequently affected by this ailment than the others. Hardening reduces the heart’s blood supply and may cause a pain (angina pectoris).

The rough surface of the wall together with the sluggish flow of blood through the narrow channels may cause a clot to from, a thrombus. A moving clot is called embolus. A thrombus or embolus or embolus may block the artery altogether. A blocked artery in the brain causes a stroke. Blockage in a coronary artery causes heart attack.

Hypertension is caused by an increased resistance to the flow of the blood. Rheumatic Fever is a disease of young persons but not always and is caused by bacteria that causes blood poisoning and scarlet fever. Congenital heart disease is an ailment present at birth. A blue baby has a congenital heart disorder. Bacterial endocarditis can be prevented by giving patients prone to infection adequate doses of antibiotics, before and after operation. Fibrillation is a condition in which the muscle fibres of the heart work without coordination with an irregular rhythm. Heart failure is a condition in which the heart does not pump efficiently, it does not mean that it stops beating, it is usually an advanced stages of heart disease. Heart attacks are one of the leading causes of death in India, they kill several hundreds a day and leave thousands of others crippled for the rest of their lives.

The heart throbs and the pulse pounds, a the first sight of your beloved, both the heart and the pulse beat faster. The heart is broken like a glass pot when your beloved rejects you for good. The heart aches at the sight of poverty and suffering. It boils at the sight of a person you hate or when you want to take revenge. The star on the silver screen steals away the heart of millions. One may be old but still feel young at heart.

We talk about heart as if it is a commodity which can be given and taken, broken or even melted. Poets have described the heart in a variety of ways. It has always been considered as the seat of great emotion and deep love. When there is deep grief, the heart starts sinking. It is overcome with joy and jumps, when we are extremely happy.

It has often been depicted in the shape of a betel leaf with an arrow piercing it to show the emotion of love. A pounding heart, bouncing heart, fluttering heart, leaping heart- its moods can be described in many ways. But all this has no co-relation whatsoever with its actual structure and function.

It is a pump working ceaselessly, day and night, supplying blood to the vital parts of the body. it does no rest even for a moment. The day it stops, we cease to exist. There is a belief that though the poor mortals live on this earth, the switch of their hearts is in the hands of God. He allows us to live, to do things according to his plan and the day he decides it he turns it off. The question is do we have nothing in our hands to help the heart? Should we leave everything to destiny and be complacent about our happiness, diseases and suffering in the way they come to us.

With a strong will and hard work many a time we can change the destiny. We can manipulate the destiny for our good. Good luck and bad luck no doubt exist in term of statistical fact. Of the million babies born in this world, some babies carry the risk of a diseased heart, often inherited from their parents. A few may be born with congenital heart diseases, which is felt at birth. Others may suffer later in life. The unlucky ones carry the defect in their genes - those biochemical bearers of coded messages in the nucleus of each cell of the body which dictates what we are or what we will be, whether we will have good health or not. Science is on the march. We are on the look-out for predicting the future by studying the genes, how to decode them, how to manipulate them by altering the make-up of the genes to our advantage for good health. This is the new science of genetic engineering. It will make it possible for us to avoid the consequences of inheriting the ailments that through birth our fathers and forefathers destined for each one of us.

There is still a long way to go in using genetic engineering and making it available to the common man. Nobody yet seems quite sure about the direction it is going to take. Until then let us work with the full knowledge, and awareness to prevent the killer No. 1 of the present age from striking in such a cavalier manner. A heart attack is always sudden, it comes when we least expect it. It may come suddenly when we are actively engaged in work or in the peak of achievement and prosperity and in fact even while enjoying good health in our forties. When it strikes, it strikes hard, giving almost no chance or time. Then all of a sudden everything turns dark, there is grief an everlasting silence. It is most pathetic lose our productive members of society, hard-driving executives, active engineers, battle-scarred military personnel an official and sedentary office workers at the prime of their existence. Many leave behind young growing children who are studying, a wife with many more years ahead of her, or may be shattered business.

Are we, in fact, so helpless? Are things beyond control? Except for a few congenital heart diseases the overwhelming majority of heart diseases is not inherited or imposed on us by an unkind nature. Unfortunately they are acquired as a result of our life style. The heart strings are yours and mint to pull. It has become the most common and devastating disease of the modern times, fostered by affluence and bred by tension. Leading cardiologist Dr. B.K. Goyal disclosed in a seminar in Mumbai that the incidence of heart diseases was increasing and that in India, today the figure of heart patients stood at 3.5 million. On the other hand the incidence of such diseases has been going down in the United States in the last 10 years because it was being tackled on many fronts. In the western world which has suffered the ravages of heart related ailments, there is growing awareness regarding the food to eat and the life style they should lead.

An undernourished person may live in unhygienic conditions and succumb to tuberculosis. A rich, well-fed, tensed up person living in clean surroundings may succumb to a bad heart. Diseases of the heart are increasing every year because the life style and the pace of modern living is getting faster. There is hope. That is if we can understand the factors which have-been contributing to heart disease and modify our way of living. We can not only significantly reduce the risk of attack, but altogether prevent this killer from striking willy-nilly.

The coronary disease is no a new disease. It has been there in the past, but definitely it is common now. A powerful Roman senator while delivering before the Senate a forceful speech, collapsed and expired before he could leave the Hall. This was attributed to the failure of his heart, a coronary malfunction. Many such deaths have become commonplace. As we grow and the years pass by there are a few changes in the internal lining and walls of the arteries. The blood vessels which carry blood from the heart suffer from degeneration in the internal lining of the blood vessels and as time goes on gradually narrowing the passage apparently, though initially, having no bad effect on the body.

This is the dreaded atherosclerosis. The vessels may gradually narrow so much more as to reduce the optimum needed blood to an extent that the organ gets only a trickle of blood. It will suffer for lack of blood and therefore lack of oxygen. The blockade of artery in the brain can cause a stroke. When the heart’s own blood supply is affected it may cause heart pain called angina pectoris. When stress is put on the heart by exertion it needs more blood, but cannot get it due to narrowed arteries and shown it off in terms of heart pain. Heart attack or myocardial infarction will occur when the blood supply is suddenly cut off completely by a clot of blood or atheroma lodged in the coronary artery the artery which supplies blood to the heart.

Atherosclerosis progresses slowly through the years starting from the childhood. Many factors help its progress. Fats or lipids or cholesterol are circulating along with the blood. When the internal living of blood vessels starts degenerating or gets injured these fats infiltrate the vessel wall. This fat consists of cholesterol, tryglycerides and phospholipids. This is why measuring levels of all these fats in blood becomes important in all heart diseases. Smooth muscle cells are the main constituent of the arterial wall. The circulating fat along with proteins called lipoproteins enter the degenerated internal lining of vessel ( called endothelium) gets deposited.

And the smooth muscle cells and connective tissue spread around this fat and protein deposits. This fat and protein undergo metabolism and are deposited in the wall of the vessels for good. They make elevated blobs of masses in the interior of the blood vessel. This elevated mass is named as plaque. There occurs calcification in advance lesions. Haemorrhage also occurs inside this plaque from small ingrowing blood vessels. Gradually the size of the plaque increases and it becomes more solid. This slowly increasing plaque mass is the real cause for myocardial infraction and angina pectoris. The blood is flowing in these vessels can be measured with an instrument which takes "blood pressure". When blood flows with a force in the vessels like a river in the rainy season when it is in spate it cuts and erodes its banks. The blood flowing with force also erodes the surface of the elevated masses of fat deposits or plaque. The surface of the plaque gets roughened and form a natural site for platlets to get stuck and aggregation can occur quickly. This helps the plaque to grow in size.

The havoc these plaques can play depends on their site. If they are there in the thighs they are also not so dangerous. But if they are in the heart or brain they can kill or paralyse. Many factors play a part in the plaque formation and the speed with which they can grow in size. Sex, age and exercise play an important role. Diabetes, obesity, smoking, diet, tension are important. If we know the risk factors, their reduction will help avoid heart diseases. With blood pressure, there is a greater risk to get a heart disease or stroke. If hypertension is more than 100 diastolic, medical intervention is justified.

Risk Factor
The seeds of heart disease are sown early in childhood. The heart disease can be drastically reduced if you reduce the risk factor in children. If a child is obese, encourage him to do exercise and eat simple carbohydrates. A study showed that 15 per cent decrease in body weight will cause 4 per cent reduction in blood cholesterol, 7 per cent improvement in peak work performed and a 16 per cent improvements in total work performed.

Members of families that are known to have a history of premature disease are fit candidates for a stroke or hypertension. Even their children may show patterns of coronary heart disease. Dr. Charles J.Glueck of the University of Cincinnati of Medicine, Tucson, U.S.A. in "Genesis of Atherosclerosis" has conclusively proved that the stage for heart attacks and strokes starts in childhood. ‘The age at which atherosclerosis is most reversible is certainly in the mid to late teens. So if we want to prevent atherosclerosis many of us feel., we have best begin at an age when it is most reversible," he advised.

His study examined the risk factors as cholesterol and tryglyceride levels in blood, high blood pressure, eating, drinking and smoking habits. Children who display impatience, time urgency and competitiveness (called type A) are far more likely to have a heart attack than those who are more easy going (called type B). The characteristics have been noticed as early as Kindergarten. We have seen five years olds who are impatient with themselves or always in a hurry", a professor of Psychiatry claims.

Children are often pressurised to use their time productively. The children are tied up with organised sports, music lessons, dancing lessons, home work, they are often busier more than most of us. "Lessons learnt at home may be most powerful"., the professor remarks. Children are encouraged to set increasingly higher goals by parents who want the best for them. Some families create lofty standards just by silently disapproving of anything less than a top job.

This does not mean that a youngster who studies hard or practices enthusiastically for a team should be discouraged. It is important to distinguish between hard work and hard driving. In short, problems arise when type-A behaviour is carried to the extreme ostensibly to help the child set a good example. Adults should be aware of their own-type –A behaviour that their children may imitate. If the dad typically dashes from meeting to meeting, it will be hard for his children to learn how to relax.

To prevent the sense of powerlessness, the children should be involved in deciding about things concerning them. It will be more soothing for a child to be asked if his problem has been eased rather than enquire about the score did he get in the test? Encourage children to do their best, rather than compare themselves to others. Set realistic goals.

Less Common Among Women
Generally women live longer than men. Coronary heart diseases are less common in women under 50 than men. This ratio is one to twelve. In the West with the prevalence of smoking, the ratio has come down to one to three. Women want to do the work of men, come down to one to three. Women want to do the work of men, accept all responsibilities and pleasures of men so they have to pay the price for it. After the age of 50 which also corresponds to menopause the occurrence of diseases is almost similar to that of men. This can also be described that risk increases in women and decreases in men after the age of 50. This is due to the fact that high risk men are already eliminated before the age of 50 by death or they already had their first heart attack. Sex difference is not much in the case of diabetic persons.

Blood Pressure
Blood pressure increases in the risk fivefold. If it is as high as 160 systolic and 100 diastolic as compared to the persons with normal blood pressure take care. If you have crossed forty five and have blood pressure you are an easier target for a heart attack or stroke.

Keeping blood pressure in check with the help of drugs is easy but to check the atheromatous changes in blood vessels is not. Of course if you can keep blood pressure in check with low fat diet, exercise and relaxation you can reduce the risk. Even then remember that good effect starts only after 3 years.

Till 1940 nobody thought of co-relating fat with heart disease. In mid-fifties a report appeared in New York Times which said : Animal fat is tied to heart diseases, cholesterol found in meat, milk and eggs is linked to atherosclerosis. By the 1960s the cholesterol theory – the notion that major risk factor is the elevated circulating fat cholesterol triglycerides became widely accepted among medical profession.

It is important to note that there is a generalised elevated level of heart attacks among the urban and industrialised population compared to the agriculture society. An increased intake of saturated fats, refined sugar and total calorie by a sedentary population is harmful. In January 1984, a report on heart after 10 years research by a heart, lung and blood institute in the U.S. clearly showed that heart diseases are associated with high cholesterol levels in blood. They suggested that the cholesterol lowering diet is the master key to preventing heart diseases and should be adopted by everyone.

Dr. Jeremiah Stamler an eminent heart researcher said: " It is reasonable to designate rich diet as the cause of the current epidemic of premature atherosclerotic diseases ranging in the Western industrialised countries".

Some heart researchers hold that it is necessary to reduce the consumption of saturated fat (animal fat as in meat, egg and ghee). The effect of unsaturated fat (vegetable oils like sunflower, soya bean or corn oil) are not so dangerous. It means that if food is cooked in ‘vegetable oil (instead of ghee or butter) you are less susceptible to atherosclerosis.

The danger is that most people consider that unsaturated fat consumption is healthy. It is not. A diet high in unsaturated fats may be toxic. A Norwegian sturdy on reducing heart diseases came to the conclusion that the best way to minimise heart diseases is to cut down on all fats of whatever kind. Avoid fried food and if you insist to eat potato fingers cut straight and cut it thick. If they are crinkle cut or thinly cut they will absorb more oil as their surface area increases. Do not put oil in your dough or batter because when frying it will be soft but will absorb more oil.

Another study of people between 40 and 59 years showed that the Japanese in general consume least saturated fat only 3 per cent of total dietary calories and suffer the least heart diseases (only 20 per thousand). In Finland, people consume 20 per cent of saturated fat calories and get the maximum: 198 coronary heart diseases per thousand. More butter and ghee consumed more the vulnerability to heart disease.

Americans have become health conscious. Their consumption of fat and, as a result, the total number of heart attacks is falling. Hundreds of thousands of people have adopted a vegetarian diet low in saturated fat and cholesterol. This movement has been given a name, Adventists. Half of them practice lacto-ovo vegetarian diet (this excludes meat but not diary products and egg). A small number of members practice strict vegan diet (no meat, diary products or eggs) which gives no cholesterol and is low in saturated fat.

Adventists who are among the most health conscious people emphasise the need for adequate exercise and abstention from smoking, alcohol, coffee, tea and spices. A well-documented study of over 24,000 Adventists in California has shown that male lacto-ovo vegetarians suffered 69 per cent as many coronary heart diseases as meat eaters while those on strict vegan diet had only 25 per cent heart disease.

Vegetarian diets differ from those of meat eaters in their content of fibre, starch, protein, vitamin and minerals. Some researchers have suggested that strong religious beliefs of Adventists also help them to protect against heart attacks. One of the most important new development of the last decade is the realization that cholesterol in the body is a far more complex substance than originally thought. Cholesterol does not travel loose in the blood but in different combination of proteins called lipoproteins. There could be low density lipoproteins (LDL) and high density lipoproteins (HDL). A high level of LDL is associated with increased risk of heart disease while a high level of HDL is associated with reduced risk. The emergence of HDL has complicated the measurement of cholesterol profile instead of serum cholesterol level has become necessary. HDL is significantly higher in women than men in all age groups. This explains why women are less susceptible to heart diseases. The HDL in part is hereditary and rises with weight reduction, exercise, cessation of smoking and relaxation.

Drugs used to reduce cholesterol levels in blood (Cholestyramine and Clofibrate) reduce the total cholesterol without discriminating the bad (LDL) from the good (HDL) cholesterol. It is better to use physical means like exercise and reduction of weight, cutting down on fat, stopping smoking and induction of the right diet which reduces bad cholesterol (LDL) and increases good cholesterol (HDL) rather than depending on drugs to reduce the total cholesterol level which does not reduce the risk of heart attack.

Cigarette Smoking
Dr. Donald S.Effler, world renowed cardio-vascular surgeon, who is credited with pioneering coronary artery bypass surgery said in an interview in Bombay. "The best suggestion, I can make to smokers is to wean away from addiction, unless people smoked sensibly may be one or two cigarettes a day and not many packets." Though he covered a wide range of subjects related to heart diseases he kept on returning to the subject of smoking. He recalled a meeting with businessmen a day earlier in a room filled with smoke. "I distributed my cards to the assembly because they would have to come to me," Dr. Effler snapped.

Cigarette smoking is harmful. Harm is done to the blood to blood vessels and to the heart. Post mortem reports of smokers show that changes take place not only in the big coronary artery supplying blood to the heart but also in the thinnest arteries which enter the wall of the heart. There is small, scattered thickening in the interior of all these arteries which causes obstruction and reduces the quantity of blood flowing in these arteries. The more cigarettes you smoke per day these changes will become more pronounced. These changes are slightly less among cigar and pipe smokers.

The smokers are susceptible to stroke, heart attacks, angina pectoris and intermittent claudication where blood vessel of legs are narrowed and there is pain in the legs after walking even a small distance and when there is need to rest before walking further. Female smokers get this problem more than men. The risk is 20 times more than in non-smokers.

In heavy smokers, who have been smoking cigarettes for several years sudden death is common. If they can cut down smoking, suddenly and sharply, the risk is definitely reduced.

When we inhale cigarette smoke, the carbon monoxide reaches the blood and combines with haemoglobin and decreases its power of carrying oxygen by five per cent. Smoking attacks us in two ways. It narrows the blood vessels and decreases the capacity of the blood to carry oxygen. We need 20 percent more of this blood to fulfil our normal requirement but the blood vessels are also narrowed due to smoking. Now you can imagine the havoc when blood is of bead quality and when it reaches in lesser quantity to the heart.

If you are a diabetic, the risk of heart disease is more. It is more prevalent in women than men. The excess risk is almost twice compared to the non-diabetic. These patients also cannot go in for a heart transplant. Immunosuppressant drugs given postoperatively to these patients make diabetes deteriorate dramatically.

If you are not keen on exercises and your work is sedentary, there is a chance of increased risk. It will increase the potency of other risk factors. A hard working farmer or dock worker has definitely a reduced risk of heart attack or sudden death. The tolerance for exercise can be increased in a coronary heart patient, through a programme of regular moderate exercise.

Sudden death and an attack of angina pectoris (pain in the chest) is commonly associated with severe anxiety. If you are person of type A qualities (aggressive, ambitious, competitive, very punctual) you have twice more risk than type B.

Sex is Good
Renowned British heart surgeon, Dr. Donald Ross, prescribed "less butter and more sex" to prevent heart diseases while answering question in a symposium on heart diseases at the Taj Mahal Hotel, Bombay, at a 3 day World Congress on Coronary Heart Diseases.

At the same seminar Dr. Narendra Singh of U.S.A. said it is difficult to define what is more or excessive sex. If you have crossed 40, have sex at least once a week, he recommended.

Inherited factor
High blood pressure in parents, increases the risk of heart attacks. Diabetes or a high level of fats (cholesterol and tryglycerides) in blood is passed on in the offsprings. Commonly, we inherit bad food habits, inactivity, obesity and smoking which they all add up to the risk.

Coronary bypass surgery is done is advanced cases where the diseased part of the blood vessel of the heart is replaced by a blood vessel taken out from another part of the body. Even a total heart is transplanted. This is done rarely as patients do not live very long after this operation.

If you have a clot in the blood vessel, drugs can be used effectively to dissolve it. One of the drugs used is heparin. The drugs are not free from side effects like bleeding through nose, bruising, fever and allergy. In less urgent cases coumarin can be used but it can cause bleeding.

If the heart is not working normally, doctors prescribe digitalis to increase the contraction and slow down the heart rate. It has a tonic action on heart. It is difficult to recommend doses. Like all drugs, digitalis also has side effects: headache, loss of appetite, nausea, vomiting, diarrhoea, tummy pain.

Angina can be treated by drugs like glyceryl trinitrate. It dilates the blood vessel and allows blood to flow more freely. It improves blood pressure temporarily and pain is relieved in a short time. It has side effects like headaches and flushing, high doses can cause spells of dizziness if one remains on his feet.

Beta Blockers
These drugs are propranolol, timolol and metoprolol. Propranolol is used for high blood pressure, helps the heart to slow down and reduces the strength of heart contractions. They are not given to people who have already had heart failure. It should not be given to pregnant, asthmatic and diabetic. Side effects are breathlessness, swelling over ankles etc. These medicaments may become necessary if the heart is diseased.

What we can do to prevent is more important. Diet can help to reduce the fats in the blood and the damage which has already been done. Cut down on fats drastically. Control blood pressure, start doing exercise and stop smoking. This will aid the heart to regain vitality. Do not look for an easy way, you will be disillusioned and misled.

Medication can give you relief. It can control blood pressure, reduce cholesterol level. It can control the rhythm of the heart beat but it will not reduce the risk of a heart attack. To save yourself from an impending heart attack, you will have to change the life style, change food habits, take more offs from work , learn to relax, develop interest in exercises, game and go on long walks. Stop alcohol, excessive tea and coffee. If you are just depending on drugs, you are treading on knife’s edge. You may any moment have a fall, then it might be too late to correct your lifelong mistakes.

Heart: Health Farming
If you had a heart attack, be calm. Lie down in bed. Do not move till the doctor arrives, examines you thoroughly and takes your cardiogram,. It is always better to get admitted to a cardiac unit of a good hospital. If hospital facility can be arranged at home, it is alright to be treated at home. Often exertion caused in moving into hospital may cause further damage to the heart. Medication is important at this stage to alleviate the pain and control the rhythm of the heart. Intravenous drips will be necessary to alleviate shock. For intravenous drug therapy the heart must be monitored continuously. The first ninety six hours are very crucial. About 90 percent of patients suffer from arrythmia called "ventricular ectopy" during this period. At this time proper medical care is crucial.

Keep calm. Do not get agitated or excited. Have a cheerful disposition. Most of the uncomplicated cases of myocardial infarction are shifted from intensive care unit to the ward or private room where the heart will still be monitored for rate and rhythm for some days more. These patients are allowed to sit in a chair a few times a day for short intervals. After 6-8 days they are allowed to walk short distances in the balcony or within the room. They are generally discharged from hospital after 12-14 days.

Resumption of sexual activity and mild exercise is allowed in 4 weeks. They are gradually rehabilitated and are allowed to return to work 6-8 weeks. In the beginning a fruit juice diet is good. Fruit juice is a source of fructose and potassium and will help in the recovery of the heart. A small quantity of honey in water with little fresh lime will be useful. Raisins soaked for 12 hours and then crushed in water and filtered are recommended. Plain water must be given from time to time. Give juices or water in small quantities and frequently. A mild laxative like Isabgol will be useful. The patient is asked not to strain himself during defecation. For the first 3-4 days the patient is given bedpan, later he can safely use a bedside commode. Afterwards all the toilet facilities. Fruits, soups, boiled vegetables and whole wheat chapati are recommended. Vegetables should be boiled with no salt. A little curd can be taken along with lunch and dinner.

If you stick to this regimen recovery will be fast, and you can work out the future course without any more heart attacks, with normal physical activity and enjoy a long more heart attacks, with normal physical activity and enjoy a long life with the help of exercise, diet, relaxation but avoiding all risk factors like smoking, drinking, high calorie food and tension.

Patients who get chest pain after moderate exertion, even after two months are advised to go for an angiogram and revascularisation surgery but in most cases it can be avoided.

Exercise is recommended, it should neither be too little nor too much. The maximum heart capacity is measured by the cardiologist and you must exercise under expert supervision. Start with short slow walks of 15 minutes and gradually increase them to 45 minutes. You can make your walks brisker as the heart gains strength. In a year’s time you may be jogging or doing strenuous exercise like any normal person of your age and capable of taking the strain which you were incapable to take before. Exercise will increase the circulation of blood to the heart. It will relax you and will bring down the cholesterol level.

Take a low calorie, low fat, high fibre food. Take fruits, cow’s milk or low fat milk for breakfast. Avoid sugar, Sugar is as bad as oil and ghee, being high calorie food without fibre, it increases cholesterol. You may have all types of fruits. The citrous fruits and apples are good. Take different fruits on different days. Suggest oranges, sweet limes, apples, pineapples, rose apples, papayas, water berries, raspberries, custard apple. Any fruit is good enough. Prefer a fruit instead of juice. They are a rich source of fibres and vitamins.

Take boiled vegetables, salads and dry whole wheat chapati and a little curd or pulses if you want to. Prefer green vegetables, leafy vegetables like parwal, white pumpkin, tinda, tori, cabbage, spinach, tomato, french beans, cauliflower, ladies’ fingers, potatoes etc. For salad add lettuce, cabbage, cucumber, carrots, tomato, beetroots, onions etc. Do not take too much salad if it causes flatulence. Eat sweet fruits like grapes, or an apple after lunch or dinner instead of a sweet dessert. A glass of juice or coconut water or vegetable juice in the afternoon is recommended. In the evenings take vegetable soup, boiled vegetable, two whole wheat chapati and fruits.

Avoid items which are difficult to digest like fried food, meat, sweet, chocolates, ice cream, cold drinks, alcohol, condiments. Take less salt. Better avoid coffee and tea or have it weak and not more than once or twice a day. Food should be easily digestible. In between whenever you feel like eating something eat fruit or drink a glass of juice.

Drink water in small quantities and more frequently rather than in large quantities at a time. Take atleast 1? and 2 litres of water a day. A glass of warm water with fresh lime and a spoon of honey (pure) is a good thing first thing in the morning. It will help you to evacuate easily. Avoid taking water along with food. Better to take 1/2 an hour before or one hour after lunch. It dilutes the digestive juices and hinders proper digestion. Chew food well. Take an early dinner. It will help you to get good sleep.

Low calorie food will bring down cholesterol and reduce strain on the heart. Do not smoke or chew tobacco. Nicotine increases heart beat and is bad for the heart. Take sun bath in the early, hours preferably before 8 a.m. Sun bathing is pleasant for about ? an hour a day. Water treatment also could be of significant help. Do not take water treatment which is too hot like sauna or steam bath.

Initially body sponging twice a day will be good. Later on take a cold pack on the legs. It helps to relax and i8nduces sleep. Take on for 45 minutes in the afternoon or before going to bed. It could be alternated with an abdominal pack when you are mobile. Have a total wash before going to bed. This will relax and induce good sleep. Foot bath with increasing temperature will help relieve chest pain. Take arm bath at changing temperature. It invigorates heart and respiration.

Avoid worries, share responsibilities. Do not get into arguments or get excited. Keep the atmosphere around cheerful. Do savasana twice a day 15 minutes each time. Learn other techniques to relax and use them more often. Meditation is useful for a heart patient. Pranayama is also useful. A heart attack is caused by your lifestyle, change it and avoid another heart attack forever.