Dr. Naresh Trehan needs no introduction. He is one of the leading cardiovascular and cardiothoracic surgeons in the world today. After graduating from King George Medical College, Lucknow, India, he went on to practice at New York University Medical Center in Manhattan USA. After returning to India, he became a leading light at Escorts Heart Institute and Research Centre. He serves as the chairman, managing director and chief cardiac surgeon at Medanta – The Medicity. Dr Trehan has been serving as a personal surgeon to the President of India since 1991 and received numerous awards, including the Padma Shri, Padma Bhushan, Lal Bahadur Shastri National Award, and Dr B C Roy Award.
Anjali Bhatia caught up with Dr Trehan to understand more about the prevailing pandemic scare and more.
Q: A new Covid variant is emerging as a threat to the world. Do we need to be scared of this variant?
A: The current variant, BF.7, is a subvariant of Omicron BA5. BF.7 cases are increasing in Japan, the USA, and a few other countries besides China. The conditions in China and India are different. In India, we have good vaccine-acquired immunity and natural immunity due to the earlier three waves of Covid infection. I think we have significant herd immunity right now and this particular variant wont cause severe infection though the number of cases in the coming week may increase.
Q: What precautions should one adopt to protect against infection, and do we need a booster dose?
A: To prevent corona or any respiratory infection, the foremost effective mode is wearing the mask properly on all encounters of exposure, especially while travelling or going to public places on public transport. It will prevent Covid as well as influenza which is also circulating in the population. Vaccination against influenza and corona is effective in reducing the severity and mortality. The new Nasal vaccine for corona seems promising, preventing infection by increasing local immunity.
Q: How do you explain the sudden cardiac deaths?
A: Sudden cardiac death is death without any prior symptoms. It can happen due to irregular heartbeat or sudden stopping of the heart. This may or may not be associated with reduced blood supply to the heart. Precipitating factors may be underlying heart diseases, familial heart problems, drug abuse, or viral infection including Covid. The cases of sudden cardiac death are more in notice after Covid. It may be related to inflammation in heart muscles, but it needs more research to associate it with Covid and also to find treatment.
Q: How can one deal with postCovid syndrome?
A: Most of the Covid infection research has shown that some patients have residual lung dysfunction, heart problems, or memory-related issues. There is no specific treatment or antidote to post Covid symptoms, but paced gradual exercise along with a healthy diet, nutrition, and sometimes medical support for heart and memory-related issues can be helpful.
Q: Some experts say the rational use of steroids is also harmful to hearts. Some deaths occur due to the gym. What is your opinion?
A: Steroids are an effective drug when used in the right amount for the right cause and the right duration under medical supervision. But steroids are also abused for recreational activities like gym and they should be discouraged. In severe cases of Covid, steroids are helpful. This was the first drug that reduced mortality. Injudicious overuse and abuse of steroids should be discouraged. In case of sudden death in the gym, while dancing, or doing sports activities, there may be underlying asymptomatic silent heart diseases like a blockage in blood vessels, muscle thickness, or inflammation in muscle. These conditions do not show symptoms at rest or during mild activity so are not diagnosed timely. Sudden and severe exertion causes sudden heart problems. Regular health check-up under the guidance of a family doctor is very helpful before starting gym activities, after Covid, or after 40 years of age.
Q: Do you think there is a need to have more research on Covid effects on health?
A: Yes, of course. The effect of Covid19 on health needs to be researched, acute as well as long term, and by these means, we will be able to understand how to recover and be able to prognosticate better. Not only this, this may give us insight into the pathology of a lot of viral infections and it may be very helpful in the future. I would like to clarify one point here. Heart attack and cardiac arrest are two things. Heart attack or myocardial infarction refers to the reduction or stoppage of blood supply to the particular part of the heart which we usually call in technical terms coronary heart disease and in layman’s terms heart attack. Cardiac arrest is a different term. Cardiac arrest means the heart stops beating, there may not be a blockage in blood vessels, but the heart stops beating because of some problems in the electrical functioning of the heart leading to sudden cardiac arrest. This may happen in a patient with a history of a heart attack, but it may also happen in somebody without any ischemic heart disease or by reduction in the blood flow in the heart. Blood pressure or hypertension or high blood pressure is one of the high-risk factors for heart attack or ischemic heart disease or reduced blood supply to the heart vessels. Other risk factors are diabetes, smoking, high cholesterol, etc. So, yes uncontrolled or poor control of high blood pressure is an important cause of heart attack.
Q: Can we say the heart of Indians is getting weaker than citizens of other countries?
A: I would say Indians are more prone to have a blockage in the heart vessels because we are the diabetes capital; we are more likely to be diabetic. Secondly, we have more visceral fat, even if we look thin, our cholesterol levels are higher than that of other people and our liver is fattier. Over time because of the abundance of food, obesity rates have gone drastically high as compared to other countries. Indian people are getting less and less sleep, the stress is increasing, and pollution is increasing. All these factors are putting Indian hearts at risk and we are likely to have more heart attacks and sudden cardiac arrests.
Q: Can those vaccinated get Covid due to BF 0.7?
A: BF 0.7 is a variant of concern and it shows immune escape. Immune escape means that already vaccinated or previously infected people can get this infection. However, natural and vaccine-acquired immunity will reduce disease severity and transmission so we must get vaccinated including booster dose.
Q: How can we prevent sudden heart attacks?
A: Prevention of sudden heart attack needs strategies on different levels. People should stop smoking and should go for regular health checkups, especially those who have a history of heart attacks, or sudden death in the family. Try to maintain an ideal weight, one hour of medium-density exercise after consulting a doctor, and six to seven hours of good sleep. If there is a family history of any arrhythmias or irregular heartbeat rhythm, they should consult a doctor. At the community level, people should be made aware of basic life support. If somebody suffers sudden cardiac arrest which is a stoppage of the heart, then what is to be done and how is it to be done? That should be taught in the community and schools on the governmental level. If there is sudden cardiac arrest where the activity of the heart seizes, a defibrillator, and welldone CPR is very helpful. So defibrillator machines should be available in public areas like airports, schools, railway stations, and bus stands in all these areas.