As winters set in, and while the chill grips Kashmir’s air, doctors roll up their sleeves to cater to the sudden spike in the load of patients suffering heart attacks, strokes and hypertension. The cardio-vascular systems of people are under duress in low temperatures and our changed lifestyles have only worsened our systemic resilience. Some caution may help.
Dr Khalid Mohiuddin, Head Department of Cardiology at Government Medical College Srinagar along with his team of cardiologists have two centers to take care of – SMHS Hospital and Super Specialty Hospital. At present, he says, the team is “overwhelmed” by the load of patients reporting with cardiac events. Dr Mohiuddin says that the impact of weather on human bodies is a “vast science” and in Kashmir, doctors have for long seen the winters precipitate some ailments. The incidence of heart attacks, brain hemorrhages and strokes definitely shoots up in winters in Kashmir, and in many parts of the world that have harsh cold months,” he says. The human body undergoes bio-chemical changes in cold weather. “For example Nitric Oxide, a vascular system’s protective agent is present in our bodies in normal temperatures but falls in cold weather. The vascular damage thus has a chance to increase,” he said.
He says that all vascular diseases, including hypertension, have poor outcomes in winters. “Every 1 degree centigrade fall in temperature will increase the chance of mortality by 0.5 percent,” he says, adding that the impact of fall of at least 30 degrees in temperature can be imagined: More deaths due to cardiovascular events. Thus a person suffering a heart attack in winters has more chance of dying than a person who got it in summers.
In the Kashmiri population, there is an add-on risk of high salt consumption. “Noon chai and high amounts of salty food is bad news. Average Kashmiri takes 8-10 grams of salt in a day. It is too high and is too bad for the heart, brain and vessels,” Dr Mohiuddin said. The risk and incidence of these health conditions is on the rise in Kashmir, doctors feel. The HoD of GMC Cardiology department said 50 years ago, the population here was not exposed to the kind of risks that they are exposed to now even though there may be very little variation in weather patterns. He attributed the spike to increase in sedentary lifestyles, unhealthy food habits, obesity, unhealthy salt consumption, smoking and pollution. “We have prepared our own recipe for disaster and winters are just the last nail,” he said.
The months from October to February also have higher levels of particulate matter in the air which puts people at a higher risk of many diseases: respiratory ailments and heart diseases broadly. Many doctors said that many populations in other parts of the world were at a lower risk even though their weather patterns were similar to ours.
At SKIMS Soura, the largest volume center for management of heart attacks, doctors are finding it difficult to admit routine patients due to cardiac emergencies being too high in number. Dr Imran Hafeez, Cardiologist at the Institute said on a single day, on Sunday, 10 patients with heart attacks were provided treatment. The number of angioplasties, he said, multiples 3 to 4 times during winters at SKIMS Soura, he said, while the average number of stents implanted shoots up to over 100 in winters as compared to around 60 in summers.
“The vasoconstriction causes the load on the heart to increase. And world over, we have seen the heart and brain suffering adverse effects when a person is exposed to cold,” Dr Hafeez said. The risk, he said, increases with further increase in the load to heart. “For example if it is cold and a person starts to shovel snow, there is a high chance of suffering a cardiac event,” he said. A patient who has a risk factor like coronary artery disease, heart disease, family history of heart disease and hypertension needs to take extra precautions. Not just exertion, but prolonged exposure to cold could precipitate a heart attack, he said. Even influenza, including COVID19 can add on to the risk, he said.
Dr Hafeez said that people need to be made aware of the chest pain and when to report it. “Chest pain needs to be taken seriously and any chest pain needs to be examined by a doctor. “Any nearest doctor can do that. Have faith in your doctors,” he said. He said a number of patients were brought to SKIMS Soura after having suffered a heart attack. “Thankfully, we now have most of them first stabilized at the periphery and this saves their lives,” he said. He said with the Save Heart Initiative, a WhatsApp group connecting doctors across Kashmir with specialists in cardiology, patients were better managed and more lives were being saved even if they were out of reach of a specialty hospital. “Save Heart has helped Kashmir’s doctors save lives,” he said.
Dr Irfan Ahmed, Cardiologist working with GMC Srinagar has also been among the pioneers of Save Heart Initiative said a study panning over 52 nations have established risk factors for heart disease and without any doubt the incidence of all lifestyle diseases, including heart attacks had increased in Kashmir as well. “Winters just make it worse,” he said. Dr Ahmed feels thrombolysis being carried out in peripheries has become a “game changer”. He said in cardiology, “time (timely intervention) is considered (savior of heart) muscle” and people, when experiencing a cardiac event, need to report to the nearest center rather than “waste Golden Hour” in traveling. “The doctors are connected and they know what is to be done,” he said.
Dr Ahmed feels heart attacks among young were “a growing concern”. He said the cardiac diseases were for a long time associated with age. “Now we have young ones with no coronary artery disease but having other factors putting them at high risk,” he said. These factors, he said, include psycho-social stress, smoking, financial distress and obesity onset at an earlier age. Stress precipitates heart conditions, he said. Rapid urbanization has put the youth at risk by changing their lifestyles: they have less mobility, more exposure to substances to abuse, more consumption of unhealthy and junk foods. He said that psychiatrists have an important role in helping manage stress.
However, across board, doctors feel there is a need to strengthen the emergencies in peripheral hospitals. Even in a Specialty Hospital, many feel, emergencies are so overloaded that even to get the attention of a doctor, people need to wait for a long time, “many of them having heart attacks”. On the other hand, the access to health insurance through Golden Cards has helped doctors provide primary PCI, a heart muscle saving procedure to many who were not in a position to afford it earlier.
Who is at risk
Hypertension
Diabetes
Heart failure
Respiratory infections
CoPD
Abdominal fat
Deranged lipids
Psychological stress
Prevention
Elderly and those with any heart condition must not get exposed to cold: Warm indoors is a must.
Layered clothing to keep warm.
No outdoor morning and evening walks. A gentle physical activity during midday, if it is sunny, indoor walks every day to be adopted.
Those at risk must avoid exertion of every kind.
Everyone to reduce salt consumption
Everyone to reduce intake of red meats
Everyone to increase intake of fruits and vegetables
Everyone to maintain a healthy weight and increase physical activity in comfortable settings.
Warning Signs
Chest Pain, pain in neck, shoulder, one or both arms
Difficulty breathing
Lightheadedness, dizziness, fainting, confusion, slurring of speech
Sudden weakness in any part of body
Excessive sweating
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.