The Winter season can be a tough time for everyone to stay healthy. The cold weather can trigger the onset of many preventive health conditions in children and adults. From the common cold to various skin ailments, the cold weather can also affect your heart, especially if you have cardiovascular disease. Hence, it is ideal to take precautionary measures while working outside the cold weather and keep an eye on our eating habits that can cause that can strain on the heart.

Understanding how cold weather can affect your heart health

In order to maintain the body temperature throughout the winter, our bodies go through specific physiological and biochemical changes. The cold can constrict your blood vessels and coronary arteries, resulting in high blood pressure, restricted blood flow, and a decreased supply of oxygen to the heart, blood clotting which can lead to a heart attack. In addition, to maintain a healthy body temperature, your heart has to work more in the cold. Hypothermia is a disorder that occurs when the body loses heat more quickly than usual, causing heart muscle damage. Children and the elderly are especially vulnerable. Elderly adults may also have less subcutaneous fat and a reduced capacity to perceive temperature, allowing them to endure hypothermia without realizing it.

Some of the healthy tips to follow during the winter are;

• Stay warm: Limit your time spent outside in the cold weather, and if you must go out, dress warmly in layers, cover your head and hands, and wear warm socks and shoes.
• Overheating oneself is not a good Idea: Overheating can occur when you dress warmly and then engage in physical activity. When blood vessels dilate too fast as a result of overheating, hypotension (low blood pressure) develops in those who have cardiac difficulties.
• Obtain a flu shot: Winter also increases your chances of catching the flu because of the low humidity caused by cold weather and indoor heating. Anyone with heart problems is at risk from the flu.
• Regular exercise: It is essential, with at least 30 minutes of activity every day in chilly weather. However, avoid exercising outside first thing in the morning. Indoor activities such as static cycling, treadmill running, and yoga are also good options.
• Maintain your diet: It is ideal to limit the amount of salt and sugar intake in your diet. Excessive sugar can cause insulin resistance, obesity, and diabetes and too much can cause water gain and high blood pressure, which can lead to heart failure, heart attack, and stroke. Avoid consuming high protein during winter, it can cause a build-up of mucus in your throat. And while cooking, use polyunsaturated cooking oils such as safflower oil or mustard oil.
• Avoid or limit your intake of alcoholic beverages:  Too much alcohol can cause blood vessels in the skin to dilate, making you feel warmer while pulling heat away from your essential organs. Hence, it is important to completely avoid or limit the amount of your intake.
• Regular Health Checks:  Everyone, including those with no medical history, should undergo regular health check-ups.

Seek help when there is an emergency

If you are feeling discomfort in your chest, fatigue, irregular heartbeats, cold sweat, breathlessness, dizziness it is important to seek immediate medical attention. This can be a sign of a heart attack and delaying treatment could turn fatal. One must ask for help and call an ambulance. Cold temperatures can be stressful. It can be hazardous or even deadly for people who have heart problems. If you’re in a chilly area, make sure you follow procedures to lower your risk. It is essential to continue to live a healthy lifestyle and eat nutritious food. Eat healthily, get enough sleep, and exercise to keep your heart healthy not just in the winter, but all year.

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As we are still in the throes of the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), its impact on the lungs and different organs of the body is a real cause of concern. Although the clinical symptoms of coronavirus disease (Covid-19), are primarily respiratory, several cardiac problems have also been observed in patients during Covid and its recovery. This is not particularly surprising as the heart and lungs both work in tangent with each other to provide oxygen-rich blood to various parts of the body. Damage to one organ can invariably have a domino effect on the heart as well, although there are several factors that contribute to this.

In order to fight the Covid-19 virus, inflammation in the body is an expected immune response. Excessive and prolonged inflammation (called cytokine storm) affects the heart, weakens heart muscles, and can lead to fluid build-up. While the Covid-19 infection by itself can invariably affect the heart, the treatment protocol required to defeat Covid-19 could cause blood clots in the arteries, which are usually managed by the medical team. Direct viral myocardial damage, hypoxia, hypotension, elevated inflammatory state, ACE2-receptor downregulation, drug toxicity, and acute myocarditis, acute heart failure, and arrhythmias appear to be among the cardiac symptoms. Elderly people and people with pre-existing heart conditions are even more susceptible to suffering from heart-related incidents triggered by Covid-19. For proper triage and management of these patients, a thorough knowledge of the hemodynamic and diagnostic implications is required.

Heart patients with or without Covid must be cautious about the following symptoms and seek medical help immediately if they experience any of these –  

• Pain or pressure in the chest while performing any activity
• Arm weakness or numbness on one side of the body
• Facial drooping on one side of the face
• Changes in speech, such as unclear or confused speech, visual impairment
• Extensive headache
• Breathing difficulties or shortness of breath at night
• Swelling in the legs
• Dizziness, fainting, or passing out

Self-care for heart patients is more important than ever during the pandemic. People must take precautions to protect themselves from the Covid infection itself, keep their heart as healthy as possible, and address any unusual signs or symptoms of heart dysfunction, particularly if they have recovered from Covid. The following are some basic tips –

1. Continue to take regular heart medications as prescribed and eat meals that are good for your heart. Reduce carbohydrates, especially refined carbs in the diet. Balanced meal plans are beneficial.
2. Keep an eye out for any existing problems and for any new symptoms or anomalies. Do not avoid visiting the doctor – if you experience any of the above symptoms, seek help immediately. Many people are prolonging doctor visits when they experience symptoms and reach the hospital late.
3. Pay attention to physical and mental health – monitor weight, avoid taking on too much stress, and find healthy ways to cope if you are dealing with stress or weight issues
4. Breathing exercises, yoga, meditation is good for the heart
5. It is recommended to take frequent breaks from sitting to promote blood circulation, stretch your legs by going outside, and stick to your regular workout program as much as possible.
6. Aim for seven to eight hours of sleep every night to get enough rest.
7. Don’t smoke or consume excessive amounts of alcohol
8.  Get regular health screenings to stay updated about your heart health

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A 78-year-old woman suffering from a faulty mitral valve in the heart recently underwent a Non-surgical Transcatheter Mitral valve-in-valve Replacement procedure (TMVR) at Aster RV Hospital, giving her a new lease of life. Previously, two such procedures have been conducted in Karnataka, making this only the third of its kind in the state. The incidence of heart valve disease increases significantly with age affecting the longevity as well as the quality of life for elderly patients. Transcatheter valve replacement procedures have come up on the medical horizon as a boon to some of these patients who are deemed unfit for open-heart surgery.

In this instance, the patient Lalitha (name changed) had already undergone open-heart surgery for a leaking mitral valve in 2013. A prosthetic tissue valve was implanted during that operation. Over the last few years, unfortunately, the surgically implanted valve had degenerated and was leaking, leading to debilitating symptoms. By the time she consulted the doctors at Aster RV Hospital in January 2021, she had already developed symptoms of heart failure –characterized by severe shortness of breath, swelling of her feet, and difficulty in carrying out her day-to-day activities. A detailed medical examination revealed that a second open-heart surgery to change this artificial valve would be of very high risk to the frail patient due to her age and the severity of her symptoms.

The Heart Team at the Aster RV hospital comprising of cardiologists, cardiac surgeons, and cardiac anesthetists decided that replacing the valve non-surgically through a Transcatheter Mitral valve-in-valve procedure (TMVR) is far less risky and relatively safer. In this procedure, a new prosthetic valve is placed within the earlier failed prosthetic valve non-surgically.

“We successfully carried out a Transcatheter Mitral Valve-in-valve (V-in-v) implantation of Edwards Sapien 3 valve through a small incision in the vein in the patient’s thigh. The procedure was done under short general anesthesia and the patient came out of anesthesia in the Cath lab just after the procedure. She recovered quickly, walked home after 4 days, and has recovered fully now. Trans-catheter valve procedures are available in India only in recent years and can be beneficial, particularly for older patients as it is possible to perform otherwise high-risk procedures without resorting to open-heart surgery and the results are very good,” said Dr. S. Venkatesh, Lead Consultant, Interventional Cardiology, Aster RV Hospital. “Therefore, these can be of great value in treating elderly, high-risk patients as well as those who have undergone prior heart operations,” he added. While transcatheter procedures are far more common for the aortic valve, they can also be useful for mitral valves and like in this case, previously implanted degenerated heart valves.

Incidentally, the first transcatheter Aortic valve-in-valve procedure in Karnataka state was also performed by the cardiac team at Aster RV hospital.

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