Golden Hour Matters - 50% Of Heart Attack Deaths Can Be Prevented With Early Treatment: Dr Kahali

With more than four decades of experience, he is known as an expert in performing Angioplasties, Mitral Balloon Dilations, Peripheral Vascular and Carotid Interventions. As President-Elect of Cardiological Society of India (CSI), he has his priorities well cut-out—to educate and economically empower patients. He minces no word in admitting that the Bengal’s ambitious and much-hyped Swastha Sathi scheme have worked wonders in economically empowering patients from even the most vulnerable section of the society. ‘Even a rickshaw-puller or a small sabjiwala can now avail of the best treatment and the best hospitals. That’s the beauty,’ he says. Some of the health schemes at the national level have also come in handy.

Speaking to Bizz Buzz, Dr Dhiman Kahali, Director of Interventional Cardiology, BM Birla Hearth Research Centre and President-elect of Cardiological Society of India (CSI), delves at length on wide-ranging issues - from heart diseases caused by air pollution, lifestyle aspects and the most modern treatment facilities that are coming up

Pollution and air pollution, in general, is a hot topic now. Air pollution is increasingly recognized as a significant risk factor for cardiovascular disease, contributing to a global public health crisis. What do you have to say about it? How does air pollution affect cardiovascular health?

Actually, fine particulate matter (PM2.5), nitrogen dioxide (NO2), and other pollutants have been linked to the development and worsening of conditions such as heart attacks, stroke, and chronic heart failure. Prolonged exposure to these harmful substances can lead to inflammation, oxidative stress, and vascular damage, ultimately compromising heart health. Air pollution is an insidious threat to cardiovascular health, affecting millions worldwide. Prolonged exposure to pollutants, such as particulate matter and nitrogen dioxide and sulphur dioxide triggers systemic inflammation, oxidative stress, and endothelial dysfunction, ultimately leading to heart diseases.

As the Director of Interventional Cardiology at BM Birla Heart Research Centre, I have witnessed an alarming rise in cases of coronary artery disease among younger patients, many of whom live in high-pollution areas. Mitigating this risk requires a multi-pronged approach—improving air quality, raising public awareness, and early detection of cardiovascular risks. Advances in interventions, including angioplasties and peripheral vascular treatments, can address the damage caused, but prevention remains paramount importance. Air pollution is not just an environmental issue; it’s a public health emergency. We must act decisively to protect the heart health of future generations.

You mentioned about chronic heart failure. Could you please explain this? What causes this?

Chronic Heart Failure (HF) is defined as inability in the heart to pump adequate blood to the different tissues of the body to perform their normal activities. So, it is failure of the heart with broader connotations. Many patients, even young patients that we see today, complain about shortness of breath or difficulty in breathing. The complaints of shortness of breath or heaviness in the chest, fullness of the abdomen, edema of the legs, facial fluffiness are very common. These patients tell us: “Sir, previously I used to walk 4 to 5 km easily but now even after going 100 metre, I am getting out of breath.” So these are the common symptoms apart from some chest heaviness, palpitation etc.

HF is common. In the US also the number of such incidence is 60 to 70 lakh and within a few years it will touch one crore. The incidence of HF is more in women than in men, because of the increased lifespan of the women and it is increasing in the society because of the fact that our longevity is also increasing and there are several comorbidity conditions in the elderly population. There are three-four types of heart failure. No. 1- heart failure with the reduced rejection fraction where the heart doesn't pump efficiently and the heart is dilated and it doesn't contract properly. So, this is a very ominous disease and you know HF with preserve rejection fraction denotes where the heart failure is there but associated with the normal pumping function of the heart.

But the complaints of the left ventricle or the left heart are less where blood doesn't come normally from the left atrium to the left ventricle because of increase in the stiffness of the heart. It occurs in cases of diabetes, hypertension, chronic kidney disease, atrial fibrillation, hypertension, heart diseases and so on. 3rd is mid ejection fraction.

This occurs due to inefficient blood pump and it is called heart failure in the mid ejection fraction. There can be 4th type of HF, which occurs with improved ejection fraction. This means the ejection fraction was 20 to 25 per cent and improved to 50 -60 per cent sometimes. We should remember in this case that patients with improved ejection fraction, should not be indulged in having plenty of food or large quantity of food.

There is also ischemic disease, right? What are the causes?

Coming to the causes of ischemic disease, it is one of the heart diseases, which is very common in our country. Hypertension and hypertensive heart disease is second common cause and then rheumatic heart disease. Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever.

Rheumatic fever is an inflammatory disease that can affect many connective tissues, especially in the heart. Untreated or under-treated strep infections put a person at increased risk. Though the number or instances of rheumatic heart disease is decreasing across many parts of the world, it is still rampant in our society and there are still a large number of rheumatic heart disease patients.

So, it is very important to identify the exact cause of HF. Isn’t it?

Yes, while diagnosing HF, it is important to diagnose, whether it is the shortness of breath or chronic obstructive lung disease. So that's very important and we can differentiate the two in many ways, like a bedside eco-cardiogram, by x-ray of the chest, and also NT pro B, NP pro. These two are very sensitive and if they are elevated, that indicates symptoms and signs of heart failure. And it is very important to diagnose or differentiate from chronic obstructive lung disease because many of these patients have secondary lung disease and congestion in the lungs secondary to the primary pathology.

So ischemic disease is very common and normally it occurs in the middle aged and elderly individuals. Ironically, in our country, we find it in lower age group patients as well. Sometimes we find that patients come with heart attack even at the age of 21. Recently I came across and treated a patient of 21 years old and he had a heart attack. We also get many patients, who are in their prime age- early 30s or early 40s.

It is also a lifestyle disease, right? And there is something called ‘golden hour’ in the context taking a patient to the doctor or hospital…

Yes, I would like to mention here that our patients come to the emergency department of the hospital very late, and not as per recommendation - that is, within 2 to 3 hours, maximum. Sometimes, HFs are associated with obstructive sleep Apnea and for that, night sleep analysis is required. We, Indians suffer from ischemic heart disease more than any other countries because of our very bad lifestyle modification measures like: we eat plenty and it contains deeply fried food like Luchi, Paratha and Samosa etc.

And our food habit is not only bad, it also contains less of fibre, less of fresh fruit and vegetables and contains deeply fried foods. And then we do much less exercise. Majority of us do not go for exercise. And many of us smoke cigarettes and it is very common cause of heart attacks at young age. Also, obesity is rampant in the society and many of us do not go for regular exercise, especially, cardiac training and that is very important. Many of our patients do not come immediately after heart attack to the hospital.

They go here and there and go for finding the doctor and if he is available then for the ECG machine. At times, they would like to believe that this is not from the heart. And all such dilly dallies cause massive damage to the heart. Remember first 2-3 hours are called the Golden Hour. Unfortunately, many patients come much after that--sometimes, after 6 to 12 hours, that is after completely damaging the heart muscle. One must remember 50 per cent of the death caused by heart attacks can be avoided if patients are rushed to the hospital within the first 2-3 hours.

Where does India stand vis-à-vis other developed and developing countries in terms of cardiac treatments?

I must say that the treatment is very robust now. There is what people call Sport Foundation Therapy. Then the medical treatment of chronic heart failure starts with a beta blockers, Diuretics as the cornerstone therapy.

Then there is Mineralocorticoid receptor antagonists and they also reduce the mortality like the other two molecule significantly. Another group is Angiotensin-converting enzyme (ACE) inhibitors which are medications that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. We have a new drug which is available in our country which improves with the heart muscle directly and it has lesser side effect.