September2018

MAROOFNEWSLETTER

29th SEPTEMBER 2018

WORLD

HEARTDAY

Maroof International Hospital

Cardiology Department

l ECG

l ETT

l StressECHO

l ArterialDopplerUpper/LowerLimbs

l VenousDopplerUpper/LowerLimbs

l AnkleBrachialIndex

l CarotidDopplerStudies

l CardiacCatheterization/CoronaryAngiography

l CoronaryCTAngiography(Non-InvasiveAngiography)

l ECHOCardiography(2D&ColorDoppler&TissueDopplerStudies)

Take care of your heart; You have only ONE for lifetime!

Stateoftheartcardiacfacilities

prize and certi�icates. Chairman MIH Ch. Naseer Ahmed addressed the employees and congratulated them for all their efforts, talking about the day's signi�icance. Maroof Hospital's building was also illuminated to celebrate the Independence Day.

Radiology Department won the competition followed by FNSD, PCD and NICU as 2nd and 3rd respectively. Other participating departments included Marketing, HR&D, F/A, ER, all OPDs & IPDs, Appointment center, MIS & Communication, Pharmacy, Physiotherapy & Rehabilitation, PSD, ICU, CCU and Laboratory.

People all over Pakistan celebrated Pakistan's 71st Independence Day with full patriotic zest. Management and all the employees of Maroof International Hospital also celebrated this day with enthusiasm and full spirit. Pakistan's national �lag was hoisted in every department.

Inter-Departmental Decoration competition was also arranged to mark the occasion. All the employees decorated their respective department with Pakistan's theme colors.

To mark the celebrations, cake cutting ceremony was also organized where winning departments were awarded with

LONGLIVEPAKISTAN

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Maroof International Hospital arranged a one day medical camp at Telenor Head Of�ice Islamabad in collaboration with Askari General Insurance Company (AGICO) on 7th August 2018. This activity was carried for providing basic health check to the employees of Telenor. This was part of the medical examination camps organized by MIH and AGICO together for the employees of their corporate clients. The camp visitors were provided with basic vital checkup including BP, sugar and weight. Free consultations were provided for ENT, General Surgery, General Medicine, Gynecology, Health & Nutrition, Dermatology and Dental checkup. CEO MIH Ch. Haroon Naseer also visited the camps. The organizing companies were awarded with souvenirs for their efforts and initiative.

MEDICALCAMP

ATTELENOR

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Sign&Symptoms:

The most common symptom is dif�iculty in breathing. The others sign & symptoms include orthopnea, paroxysmal nocturnal dyspnea, weakness, fatigue, apprehension, palpitation, sweating, paler, cyanosis, cold peripheries, decrease urine output, pulmonary edema, peripheral edema, ascites, raised JVP, Tachycardia, tachypnea, hypotension, hypoxia etc.Diagnosis:

Echocardiography, ECG ,Chest X ray, Holter monitoring, Blood tests like BNP, Pro BNP, Cardiac biomarker Serum electrolytes , Renal function test, liver function tests, Thyroid function tests, Complete blood count, CRP, Blood sugar level, ESR, Viral serology, Auto immune workup, Cardiac CT&MR , Cardiac catheterization and cardiac biopsy.

Management

Treatment focuses on improving the symptoms and preventing the progression of the disease. Reversible causes of the heart failure also need to be addressed (e.g. Infection, alcohol ingestion anemia, thyrotoxicosis, arrhythmia and hypertension). Treatments include l i festyle and pharmacological modalities, and occasionally various forms of device therapy and rarely cardiac transplantation.

Acute decompensated heart failure managementIn acute decompensated heart failure, the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that, airway, breathing and circulation, breathing, are adequate. Immediate treatments usually involve some combination of vasodilators such as nitroglycerine, diuretics such as furosemide, and possibly noninvasive positive pressure ventilation (NIPPV). Supplemental oxygen is indicated in those with oxygen saturation levels below 90% but is not recommended in those with normal oxygen levels on room air.

Chronic heart failure managementThe goals of treatment for people with chronic heart failure are the prolongation of life, the prevention of acute decompensation and the reduction of symptoms, allowing for greater activity.

Heart failure can result from a variety of conditions. In considering therapeutic options, it is important to �irst exclude reversible causes, including thyroid disease, anemia, chronic tachycardia, alcohol abuse, hypertension, and dysfunction of one or more heart valves. Treatment of the underlying cause is usually the �irst approach to treating heart failure. However, in the majority of cases, either no primary cause is found or treatment of the primary cause does not restore normal heart function. In these cases, behavioral, medication and device treatment strategies exist which can provide a signi�icant improvement in outcomes, including the relief of symptoms, exercise tolerance, and a decrease in the likelihood of hospitalization or death.

4)CongestiveheartfailureHeart failure may also occur in situations of "high output" (termed "high-output heart failure”, where the amount of blood pumped is more than typical and the heart is unable to keep up. This can occur in overload situations kidney diseases, chronic severe anemia beriberi (vitamin. B1/thiamine de�iciency), hyperthyroidism, cirrhosis, Paget's disease, multiple myeloma, arteriovenous �istulae, or arteriovenous malformations.

5)Acutedecompensatedheartfailure.A condition in which there is sudden deterioration of symptoms of heart failure in patients with chronic stable heart failure. This most commonly results from an intercurrent illness (such as myocardial infarction (heart attack), pneumonia, abnormal heart rhythms, uncontrolled hypertension, or a patient's failure to maintain a �luid restriction, diet, or medication.

6)DiastolicHeartfailure.In this condition the patients have sign & symptoms of heart failure but heart Ejection Fraction (EF) remains normal. This occurs due to increased stiffness or decreased relaxation of heart muscle as a result of that patients have symptoms of low cardiac output.

7)Acuteheartfailure.When symptoms appears within 6 weeks of heart failure.8) Chronic Heart Failure. When symptoms appears more than 6 weeks after onset of heart failure.

CAUSES:

The most common cause is ischemic heart disease. The others causes include Myocarditis, Valvular heart disease, Hypertension, DM, Cardiomyopathy, Arrhythmia, Vasculitis, Chronic kidney disease, Drugs, Pregnancy, Metabolic causes, Congenital heart disease, Pulmonary disease, connective tissue disorder, cardiac surgery & Trauma .

Epidemiology:Heart failure affected about 40 million people globally. Overall around 2% of adults have heart failure and in those over the age of 65, this increases to 6–10%. Above 75 years old rates are greater than 10%.

Rates are predicted to increase. Increasing rates are mostly because of increasing life span, but also because of increased risk factors (hypertension, diabetes, dyslipidemia, and obesity) and improved survival rates from other types of cardiovascular disease (myocardial infarction, valvular disease, and arrhythmias). Heart failure is the leading cause of hospitalization in people older than 65.

TYPES

1)Left-sidedfailure.The left side of the heart is responsible for receiving oxygen-rich blood from the lungs and pumping it forward to the systemic circulation. (The rest of the body except for the pulmonary circulation). Failure of the left side of the heart causes blood to back up into the lungs, causing respiratory symptoms as well as fatigue due to insuf�icient supply of oxygenated blood.

2)Right-sidedfailure.Right-sided heart failure is often caused by pulmonary disease (cor pulmonale), which is usually caused by dif�iculties of the pulmonary circulation. Such as pulmonary hypertension or pulmonic stenosis.

3)Biventricularfailure.In this condition both side of heart is involved and patients have symptoms of both left and right sided heart failure.

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen.

At �irst the heart tries to compensate this by:

l Enlarging. The heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time this causes the heart to become enlarged.

l Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly.

l Pumping faster. This helps increase the heart's output.

l The body also tries to compensate in other ways:

l The blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power.

l The body diverts blood away from less important tissues and organs (like the kidneys), the heart and brain.

l These temporary measures mask the problem of heart failure, but they don't solve it. Heart failure continues and worsens until these compensating processes no longer work.

Eventually the heart and body just can't keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The body's compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline.

HEART FAILURE

Dr.ImranGhaniKhattakConsultant Interventional CardiologistMBBS, M.D (USA), FCPS (Cardiology)

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HistoryandSymptoms:Often patients with cardiac disease have other problems including impaired lung function, limiting their mobility and exercise ability. Depending on the speci�ic heart condition, the patient may present with dif�iculty breathing, shortness of breath, swelling, night waking, fatigue, fainting, chest pain, heart palpitations, dizziness, or pain in the legs during exercise due to circulation problems.

PhysicalExam:Physical examination includes determination of heart rate, swelling, and heart sounds as well as assessment of breathing.

DiagnosticProcess:Physicians will use tests for cholesterol levels, diabetes, and kidney disease. Electrocardiogram helps to identify structure/blockages and rhythm problems of the heart. Chest x-rays may be useful, and echocardiogram (ECG) can be performed. Cardiac stress testing is used to evaluate tolerance to exercise.

RehabManagement:Cardiac rehabilitation refers to a structured program of exercise and education designed to help you return to optimal �itness and function following an event like a heart attack

There are four phases of cardiac rehabilitation. The �irst phase occurs in the hospital after your cardiac event, and the other three phases occur in a cardiac rehab center or at home

PhaseOneCardiacRehab:TheAcutePhaseThe initial goals of phase one cardiac rehabilitation include:l Assess your mobility and the effects that basic

functional mobility to ensure that appropriate discharge planning occurs

Cardiac Rehabilitation

Condition:The goal of cardiac rehabilitation is to restore and improve function, limit disability, minimize risk factors, and optimize cardiac conditioning through exercise and education speci�ic to patients with heart disease.

Background:Cardiovascular disease is the leading cause of death and disability in the United States. Cardiac rehabilitation is underutilized in the Pakistan, with an estimated participation of only 10-20% of eligible patients.

RiskFactors:Risk factors for developing cardiac disease include increased age, male gender, history of vascular disease, and family history as well as reversible factors, such as diabetes, high blood pressure, high cholesterol levels, obesity, smoking, stress, and diet.

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Dr. Fatima Khalid. PTDPTRehabilitation Department

l Prescribe safe exercises to help you improve your mobility, and to improve cardiac �itness

l Help you maintain your sternal precautions is you have had open heart surgery

l Address any risk factors that may lead to cardiac events

l Prescribe an appropriate assistive device, like a cane or a walker, to ensure that you are able to move around safely

PhaseTwoCardiacRehab:TheSubacutePhasePhase two of cardiac rehabilitation usually lasts from three to six weeks and involves continued monitoring of your cardiac responses to exercise and activity.

Another important aspect of phase two cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise. This phase centers around your safe return to functional mobility while monitoring your heart rate.

Towards the end of phase two, you should be ready to begin more independent exercise and activity.

PhaseThree:IntensiveOutpatientTherapyPhase three of cardiac rehabilitation involves more independent and group exercise. You should be able to monitor your own heart rate, your symptomatic response to exercise, and your rating of perceived exertion (RPE). Your physical therapist will be present during this phase to help you increase your exercise tolerance

BENEFITSOFCARDIACANDPULMONARYREHABl Strengthen and condition your heart and lungsl Control your weight and lower your total cholesterol

levels through good nutrition and physical activity understand your medications

TESTIMONIALS:

IngredientsWater 1 cupMint leaves 10-12Juice of 3 LemonsSalt/black salt 1 pinchBlack pepper 1 pinch (optional)7up/SpriteIceMint leaves for garnish

Method1. In a blender, add water, mint leaves, lemon juice,

salt/black salt, black pepper and ice.2. Blend until incorporate.3. Add mixture equally in 3 glasses. Add ice, pour

7up/Sprite.

Garnish with mint leaves and serve immediately.

EatHealthy

I joined in late night with extreme labor pain and i already had 3 scars before, & it was the 4th C section but the way staff handled my situation with such love, care & vigilance, I really appreciate your efforts. You all showed up great team work. Keep up the good work.

(AsthmaNabeel)

Your doctors and entire medical team has treated us very well. They were very cooperative and careful during all the process. My mother was satis�ied with the treatment and attitude. They treated her like a family member. Thanks to MAROOF International Hospital.

(Mr.Tariq)

WhatDoesDiabetesDotoYourHeartDiseaseRisk?

Many people have both conditions.Take Actions & Stay SafeIf you smoke, it's time to quit. Set a date and talk to your doctor. If you've tried to quit before, it's not too late. Many people try several times before they kick the habit for good.

Nearly everyone with diabetes can bene�it from getting more exercise. It's good for your heart and helps control your blood sugar. Even brisk walking counts, so you don't need a gym.

If you're not active now, let your doctor know you want to get started. She can let you know what's safe for you to do.

Some people with diabetes need to take medicine to lower their blood pressure or improve their cholesterol levels. Your doctor may recommend that you take a daily low-dose aspirin to protect against heart disease.

Be sure to keep up with your medical care. Go to all your appointments and let your doctor know how you're doing. Together, you can work toward a healthier heart.

Many people with diabetes also have heart disease. When you do things to take care of your diabetes, like manage your blood sugar, exercise, and eat a healthy diet, that's also good for your heart.

It's important to understand your risk and how you can lower it.

Besides diabetes, do you also have:l A waist that's larger than 35 inches in women or 40

inches in men?l Low levels of "good" ( HDL) cholesterol?l High levels of "bad" (LDL) cholesterol or triglycerides

(another type of fat in the blood)?l High blood pressure?l Even borderline elevated at 130/85

If you're not sure, your doctor can check all those numbers for you.

Also, do you:l Smoke?l Have a family member with

heart disease?l Eat a diet high in saturated fat,

cholesterol, and sugars?

TypesofHeartDisease

People with diabetes are at risk for:Coronary artery disease: Your coronary arteries are in your heart. Fatty deposits, called plaques, can narrow them. If plaque suddenly breaks, it can cause a heart attack.

Exercise, eating a healthy diet, and not smoking are musts. It could be from coronary artery disease or from the diabetes. It can be dangerous and fatal, so aggressive management and follow up is essential.

Congestive heart failure: This is an ongoing condition in which the heart loses the ability to pump blood effectively. The main symptoms are shortness of breath when you're moving and leg swelling.

MintMargarita

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Mr. Nadeem Hassan from PCD was selected as employee of the month for May 2018. He was awarded with certi�icate and cash prize by CEO Ch. Haroon Naseer and Mrs. Mussarat Naseer HoD MMD. Medical Director Mr. Mehmood Jamal and CFO Mr. Afsar Ali were also present.

EmployeeoftheMonth