Caring Hearts Jan - Mar 2022

JANUARY - MARCH, 2022|CARING HEARTS|1



Chairman’s
MESSAGE

Dear Members of the Heart Care Foundation,

It is with immense pleasure that I wish you a very Happy New
Year. We have gone through so much of difficulties and perils
during the last couple of years from the global pandemic and it
still continues. But we hope that by the end of the year we will
see brighter light at the end of the tunnel and let us live in hope
and faith and let us not give up the confidence which we have
in our life and in our future.

We have people all around us who suffered a lot from the

Padma Shri Awardee pandemic, people who lost their jobs, people who failed in their
Dr. Jose Chacko Periappuram businesses and enterprises for no fault of theirs and people who
Chairman, Heart Care Foundation has lost their dear and near ones. Let us open our eyes to see
the perils and difficulties and aches and pains of the people who

are going through such difficulties and try to help them in whatever means and ways we can.

In this context I remember a small story of king Akbar, who entrusted his faithful associate Birbal to
locate the number of people who are blind in his kingdom. Next day people found Birbal sitting on the
roadside posing as a cobbler. A lot of people went by and asked him “what are you doing”? And they in-
cluded King Akbar also, who happened to see his faithful commander Birbal sitting on the roadside fixing
foot wears. He too asked him, “What are you doing here?” Birbal did not answer anybody.

One week later Birbal gave the list of blind people in the kingdom. King Akbar was put off by seeing his
name also in the list. Akbar asked him why his name is in the list. “You also asked me what I was doing
on the roadside in spite of seeing what I was doing. So you also will fall into the list of blind people.”

We see lot of things around us but sometimes we ignore them and that is called laziness. Sometimes we
see it, but don’t register it, that is called defiance. Let us not be defiant or lazy to see what’s happening
around us. Let us see the problems that are happening all around us, let us not be blind. We see lot of
things with our eyes but do not register it in our brain. Let us try to see what is happening around us, the
sufferings, the difficulties, and let us register it in our brain and try to help those who deserve it.

At present the “Caring Hearts” is in a print format, but from this edition onwards we are bringing it as an
online flip version also, which we will be sharing with people through their WhatsApp and Email. Please
be kind enough to go through it, comment and give your suggestions as well, and if you like it please
share it with your friends and groups so that the messages from the Heart Care Foundation reach further
and deeper into the minds of many. This will get us more help and memberships for the Heart Care Foun-
dation, and we will be able to help a lot more needy people.

Thanking you
Yours Sincerely

Dr. Jose Chacko Periappuram
Chairman, HCF

JANUARY - MARCH, 2022|CARING HEARTS|3

ADVISORY BOARD MEMBERS 03 Chairman’s Message
•Mr. C.J. George 05 Editor’s Page
•Mr. Alex Muthoot 06 Childhood obesity and risk of
•Dr. V.P.Kuriyipe developing future cad
•Mr. Johnson Mathew K  09 Understanding your Genes
•Fr. Johnson Vazhappilly 10 Coronary artery disease in young adults
•Fr.Jose Alex Oruthayapilly 12 Changing your diet could add up to a
•Dr. Junaid Rehman decade to life expectancy, study finds
•Dr. V.P.Gangadharan 13 HCF Archives
•Mr.Justice(Rtd) Cyriac Josephww 14 New era of conjuring deaths in young
•Mr.Justice (Rtd)Kurian Joseph 18 Healthy lifestyle changes for youth
•Mr. Bipin Andrews 22 Exercises and the risk of heart attack
•Dr. Philip Augustine 25 Having a good listener improves your
•Mr. Shibu Philips brain health
•Dr. M.R.Rajagopal 27 New gen lifestyle and heart disease
•Fr. (Dr)Paul Karedan 29 Is xenotransplantation the answer
•Mr. E K Premachandran to the donor organ shortage?
•Adv. Bijoy Cheriyan 30 The No-Gym
•Mr. Bindu Madhav 31 HCF News
•Mr. M.I.George 32 We need your help...
•Mr. John Poomkudy 35 HCF Trustees
•Mr. Nelson Pavunny
•Adv. Peeyus A. Kottam
•Mr. M.K.Babu
•Mr. K.N.Marzook
•Mr. Mathew Tharakan
•Mr.Justice (Rtd) K. Narayana Kurup
•Mr. Stanley Kunjipalu
•Mr. T.A.Varkey
•Mr. T.P.Tomy
•Dr. Gregor Williams

TRUST MEMBERS
•Dr. Jose Chacko Periappuram (Chairman)
•Mr. Raju Kannampuzha (Secretary)
•Adv. K.K.Chacko Anathanam
•Mr. George E.P.
•Dr. Jacob Abraham
•Dr. Jo Joseph

MEDICAL PANEL
•Dr. Rony Mathew Kadavil (Chairman)
•Dr. Jayakumar T. K
•Dr. Alexander Thomas
•Dr. Ali Faizal
•Dr. Anand Sreenivasan
•Dr. G.Babu Vasudevan
•Dr. C.G.Bahuleyan
•Dr. Binu Ramesh
•Dr. Geevar Zachariah
•Dr. George Jacob
•Dr. Govindan Unni
•Dr. Jaideep C Menon
•Dr. V. L. Jayaprakash
•Dr. Johny Joseph
•Dr. Mathew Abraham
•Dr. P.P.Mohanan
•Dr. Rajan Joseph Manjooran
•Dr. Saji Kuruttukulam
•Dr. Edwin Francis
•Dr. Thomas Mathew

EDITORIAL PANEL
•Mr.P.Krishna Kumar (Chief Editor)
•Dr. Jo Joseph
•Mr. Dinesh P. Thampi
•Dr. Nisha Vikraman

PROGRAMME CO-ORDINATOR
•Mr. Stephan Pascal

Conceived, Edited & Designed by
•[email protected]

4|CARING HEARTS|JANUARY - MARCH, 2022

Editor’s PAGE

Mr. Krishna Kumar P. 2022,the year looked upon with a lot of hope and antici-
Chief Editor pation after the miserable anxieties and uncertain-
ties of the last 2 years. The year started with some promises all right,
but then the new variant of Covid is again making normal life near
impossible. Endemic or a continuation of the pandemic? Debates are
on as usual. Let us pray it’s the former.

Heart diseases and deaths due to cardiac arrests were always looked
upon with dread by everyone and on hearing the news the first gener-
al question will be, “How old was she/he”? The younger the age of
the deceased, the more pronounced the show of shock and disbelief.
And when it is a youngster, the anguish and the feeling of unfairness
is profound.

Statistics prove that the issues of the heart and deaths due to heart
problems are on the rise amongst our youth. We may blame their life
style or family history, but it is a fact that many seemingly fit young-
sters fall victim for no apparent reason. Who is to blame? How can
we prevent it or can it be prevented at all? This edition of Caring
Hearts takes an in-depth look and brings you as much information as
possible. Experts from various medical fields have put their collective
thoughts in this edition and this will be yet another copy to store for
future reading.

Heart Care Foundation is a charitable organization that depends ful-
ly on the benevolence of friends and supporters like you. Please take
a bit of your time to read “We need your help..”, a passionate appeal,
given at the end of the magazine, by Dr. Jose Chacko Periappuram,
the Chairman of Heart Care Foundation and do your best to assist
the Foundation in any which way you, your friends or relatives can.
If your subscription is about to end or has already expired, please do
consider renewing.

Help us, to help those in dire need!

Wish you a Healthy, Happy and Hopeful 2022!

KRISHNA KUMAR

JANUARY - MARCH, 2022|CARING HEARTS|5

Coverstory

CHILDHOOD OBESITY
AND
RISK OF DEVELOPING
FUTURE CAD

alence of associated co- morbidities. are overweight and 11% are obese.

This results in an enormous burden Both are known to have significant

of obesity –related diseases. Certain impact on both physical and psycho-

co-morbidities such as type 2 diabetes logical health. About 70% of obese

mellitus and steatohepatitis that were adolescents grow to become obese

considered adult diseases are now reg- adults. The prevalence of childhood

ularly seen in children with obesity. obesity is increasing in developed

Dr. Vivin Abraham Obesity during adolescence increases as well as developing countries.
MD (Ped), IDPCCM the risk for cardiovascular disease and Environmental factors, lifestyle pref-
Consultant Pediatrician and premature death during adulthood. erences, and cultural environment
Intensivist Cardiovascular events primarily occur play a pivotal roles in the rising
Lisie Hospital, Cochin in adulthood, the atherosclerotic prevalence of obesity worldwide.
process may begin in childhood. For The Centre for Disease Control
INTRODUCTION most children, vascular changes, if and Prevention defined obesity as
present are mild and can be mini- at or above 95th centile of BMI for
Obesity has become one of mized with adherence to a healthy age and “at risk for overweight “as
the most important public lifestyle. However in some children, between 85th to 95th percentile of
health problem in USA and the atherosclerotic process is acceler- BMI for age.
ated because of presence of identifi-
able risk factors. There is supporting evidence that
excessive sugar intake by soft

many countries. As the prevalence of Obesity drinks, increased portion size, and

obesity increases, so does the prev- Twenty five percent of children in US steady decline in physical activity

6|CARING HEARTS|JANUARY - MARCH, 2022

have been playing major roles in the The prevalence of childhood obesity is
rising rates of obesity. increasing in developed as well as devel-
oping countries. Environmental factors,
Cardiovascular lifestyle preferences, and cultural envi-
ronment play a pivotal roles in the rising
Obesity is associated with a number prevalence of obesity worldwide.
of cardiovascular changes that are
linked to increased cardiovascular velopment of aortic and coronary arte- in early adolescence. The long term
risk in adulthood. Two risk factors
– hypertension and dyslipidemia rial fatty streaks and fibrous plaques implications of metabolic syndrome
are components of the metabolic
syndrome. A minority of children and increased arterial stiffness. are unknown. As a result, screening
and adolescence with obesity have
no evidence of cardiovascular risk Adult cardiovascular disease and treatment should be focused
factors(metabolically healthy obesi- on individual cardiometabolic risk
ty). Cardiovascular risk in children The origins of adult cardio vascular factors (obesity, dyslipidemia, dys-
is stratified based on multiple risk disease begin in childhood and ad- glycemia and hypertension) while
factors including obesity, lipids, olescence with evidence that pres- recognizing that these are clustered
blood pressure and the presence of ence of high BMI in adolescence is together.
other co-morbidities. associated with cardiovascular disease

Hypertension and acute cardio vascular events in

The risk of hypertension is in- adulthood.
creased in children and adolescence
with overweight and obesity and Type 2 diabetes mellitus
increases with severity of obesity.
It was found that the prevalence of Subclinical insulin resistance is com- Causes of obesity
hypertension was approximately mon among adolescence with obesity
4% and 9% respectively in children and is an important predictor of devel- Although the exact mechanism
with moderate and severe obesity oping type 2 diabetes mellitus during is not known, it is confirmed that
respectively. adulthood. The reported prevalence obesity occurs when energy intake
of prediabetes and type 2 diabetes in exceeds energy expenditure. There
Dyslipidemia children with obesity varies consid- are multiple etiologies for this
erably because of different degrees imbalance and the rising prevalence
Dyslipidemia occurs in children and of obesity, racial and ethnic variation cannot be addressed by a single eti-
adolescence with overweight and and age range of sampled population. ology. Genetic factors influence the
obesity, particularly with central fat susceptibility of a child to an obesity
distribution and increased adipos- Metabolic syndrome – conducive environment. Environ-
ity. The typical pattern is that of mental factors, lifestyle preferences
elevated concentration of serum low The “metabolic syndrome” is used to and cultural environment seem to
density lipoprotein and triglycerides describe the clustering of metabolic play major roles in the rising preva-
and a decrease in high density lipo- risk factors of T2DM and atheroscle-
protein. rotic cardiovascular disease in adults: >>>
abdominal obesity, hyperglycemia,
Premature atherosclerotic cardio- dyslipidemia and hypertension.
vascular function Clustering of cardiovascular risks
occur in children and adolescence
Childhood obesity is associated with obesity. The presence of obesity
with several markers of subclini- in early childhood predicts increased
cal atherosclerosis. These include risk for metabolic syndrome and other
endothelial dysfunction, carotid inti- biomarkers of cardiometabolic risk
ma-media thickening, premature de-

JANUARY - MARCH, 2022|CARING HEARTS|7

Coverstory

Dr. Vivek Thomas
MD (Gen. Med), Dr NB
(Cardio), Cardiologist,
General Hospital, Thrissur

lence of obesity worldwide. 3. TV Watching Let me begin with a story of
three friends who build their
Among children, most common a) Restrict TV viewing houses. One build his house
obesogenic behavior includes high out of palm leaves, one out of plastic
consumption of unhealthy foods, b) Reduce eating in front of TV and the other one used bricks and
low levels of physical activity, high cement.
levels of mental stress, high levels of c) Ban or restriction on television
screen time and poor sleep pattern. advertising to children Genetic makeup is an architectural
blue print for a building. We all have
Intervention strategies for preven- 4. Food sector unique blue print that dictates how
tion of childhood obesity our house, our body, gets built. Al-
a) Applying a small tax on high vol- though these specification are fairly
1. Build environment ume foods of low nutritional value scripted, how these specifications
are interpreted and acted upon will
a) Walking – provide designated safe b) Food labelling and nutrition sign- determine the long term resilience
walking path post(eg logos for nutritional food) and longevity of the structure.

b) Cycling – provide designated c) Implementing standards for product All three friends had the same
cycling routes formulation instruction – ‘Build the house’. But
each person chose different raw
c) Public open spaces Conclusion materials which resulted in very
different results. If you build your
d) Recreational facilities to be pro- Obesity is a chronic disorder that house with inferior materials, you
vided which are safe and inexpen- has multiple causes. Overweight and will have more maintenance prob-
sive obesity in childhood have significant lems. The house will not last long
impact on both physical and psycho- compared to using superior materials
2. Physical activity logical health. and careful craftsmanship. Likewise,
for the same genetic code, for exam-
a) Increase sports participation Primary or secondary prevention ple, identical twins, outcomes can
could be the key for controlling the be very different depending upon
b) Improve and increase physical current epidemic of obesity. These individual lifestyle choices.
education time strategies seems to be more effective
in children than adults. The target Family history is an important
c) Use school report cards to make environment could be built at home, predictive factor for your health. So
parents aware of their children’s pre-school, school and other institu- it is imperative for each one of us to
weight problem tions. Further research is needed to
determine the most effective strate-
d) Enhancing active modes of trans- gies of intervention, prevention and
port to and from school treatment of obesity.

Eg walking, cycling, public transport

8|CARING HEARTS|JANUARY - MARCH, 202222

Understanding

your GENES

take the time to find as much as we For yourself, find out your preventive Coronary artery
can about the health of our relatives, status and what you can do to improve disease has a com-
especially our blood relatives. the status. Try to adapt all preventive plex etiology, main-
strategies to reduce the risk for cor- ly a combination
In the cardiac perspective, you need onary artery disease and stroke. For of traditional risk
to be interested in finding out wheth- this, knowing your numbers is very factors and genetic
er anyone in your family – Your par- important_ Your cholesterol, blood predisposition. Tra-
ents, brother, sister, uncles, aunts or sugars and blood pressure need to be ditional risk factors
grandparents ever had a heart attack, monitored regularly. include diabetes,
stroke, angioplasty, bypass surgery high blood pressure,
or aneurysm. If any of your relatives Coronary artery disease has a com- high cholesterol and
has passed away, you need to find plex etiology, mainly a combination cigarette smoking
out how old they were when they of traditional risk factors and genetic
died and the cause of their death. If predisposition. Traditional risk factors the role of genetic risk scores com-
the relatives with heart disease were include diabetes, high blood pressure, pared to traditional risk factors for
younger, especially male relatives high cholesterol and cigarette smok- prediction of heart attacks. It was
with heart disease at age less than 55 ing. However these are not sufficient found that addition of genetic risk
and females with age less than 65yrs to identify high risk asymptomatic score to traditional risk factors was
or multiple relatives having heart individuals and do not explain all the statistically superior in identifying
disease regardless of their ages, you causes of heart attack. In fact, he- high risk individuals. But tradi-
really need to get more information reditary influence on coronary artery tional risk factors have been poorly
about the relatives and about you. disease susceptibility accounts for controlled in the general population
about 40-50% of cases. and there is high cost for deter-
In relatives, you need to find out if mining genetic risk score. Hence it
they had any risk factors like diabe- Genomic studies have been used to is important to remain focused on
tes, high blood pressure, high cho- create genetic risk scores to improve preventing and controlling tradi-
lesterol and smoking. Also whether risk prediction for coronary artery tional risk factors until the role of
the diagnosis of heart disease was disease. A study was done in the Por- genetics is better understood.
already confirmed or just presumed. tuguese island of Madiera, to evaluate
Finally, I do not imply that if you
don’t have a family history, you
get to be a slacker about preven-
tive effort. But if anyone need to
be obsessed with this stuff, it’s the
person with strong family history of
heart disease.

JANUARY - MARCH, 2022|CARING HEARTS|9

Coverstory

A good teacher become a hard lession

Coronary artery disease

in YOUNG ADULTS

Dr. Anaz Bin Azeez Coronary artery disease is in older adults these gains have not
Senior Specialist , the buildup of plaque in the extended to younger adults.Infacts
Department of arteries that supply oxygen acute myocardial infarction rates
Cardiac Sciences rich blood to the heart. Plaque causes have increased among young adults
Aster MIMS Hospital, a narrowing or blockage that could age 35 to 54 years , particularly in
Calicut result in a heart attack. Symptoms women. Attention need to be paid to
include chest pain or discomfort this younger population.
10|CARING HEARTS|JANUARY - MARCH, 2022 and shortness of breath. Treatments
include lifestyle changes and medica- Although any CAD before 55 years
tions that target the risk factors and / for men or 65 years for women is
or possibly surgery. Coronary artery labeled PREMATURE it is partic-
disease is a narrowing or blockage of ularly alarming when CAD occurs
the coronary arteries usually caused in the young defined as onset before
by the buildup of fatty materials age 45 years. CAD in young adults
called plaque.Coronary artery disease carries a poor long term prognosis
also called ischemic heart disease, and as many as 4% to 10% of acute
coronary heart disease and heart myocardial infarction events occurs
disease. in this age group. It is paramount to
better understand conventional and
The consequence of premature cor- unique risk factors to prevent ath-
onary artery disease are devastating. erosclerotic cardio vascular disease
Although atherosclerotic cardiovascu- (ASCVD) events in this population .
lar disease events have been declining an adage states “ if experience is the

better teacher , the worst experience blood cells to attack causes more was the strongest modifiable factor

teach us the best lessons “. Thus inflammation .this triggers yet other for recurrent major adverse cardiac

what can survivors of early onset cells in the artery wall to form a soft events (MACE) .In sum of this

CAD teach us about risk, not only cap over the plaque. This thin cap study helped shedlight on factors

for their initial event but for future over the plaque can break open. Blood associated with progression and

events ! cells fragments called PLATELETS opportunities for enhanced preven-

Coronary artery disease is caused stick to the site of injury causing a tion. becuase recurrence rates are so
by atherosclerosis . atherosclerosis clot to form . the clot further narrows high even more efforts needed to be
is the buildup of plaque inside the the artery . sometimes a blood clot directed toward preventing the de-
arteries. Plaque consist of cholester- breaks aprt on its own. Other times velopment of coronary artery disease
ol , fatty substances, waste products, the clot blocks blood flow through the in the first place through primordial
calcium and clot making substanc- artery , depriving the geart of oxygen and primary prevention efforts as
es fibrin . as plaque continues to and causing a heart attack. outlined in the “ABCDE” approach
collect on artery walls, then artery in the 2019 American College of
become narrow and stiffen.Plaque An observational study called AFIJI Cardiology (ACC)/ Americal Heart
can clod or damage the arteries , ( APPRAISAL RISK FACTORS IN Association (AHA) primary preven-
which limits or stops blood flow to YOUNG ISCHEMIC PATIENTS tion guideline.
JUSTIFYING AGGRESSIVE

the heart muscle. If heart can’t get INTERVENTION ) done in 880 Determination of the presence of

the oxygen and nutrients it needs to adults who experienced symptomatic atherosclerosis in youngers adults

work properly. This condition called CAD at a young age <45 . key study is of paramount importance. The

ISCHEMIA .not getting enough finding were as follows 1) recurrence intial studies of atherosclerosis in

blood to the heart muscle can lead to rates remained high despite medical young adults were limited to autopsy

chest discomfort or chest pain called therapy ,2) recurrent events generally studies in war veterans from the

as ANGINA PECTORIS .It also puts occurred from new coronary lesions 1950. Today , both invasive and

at risk for a heart attack. which confirms prior work showing non invasive imaging can be used

CAD happens in everyone .the speed that nonobstructive plaques are the to identify atherosclerosis burden
vulnerable ones, more prone to rapid and progression . persons age 40 to
at which it develops differs from 75 years , if risk based decisions to
person to person . the process usu- progression and 3) clinical factors initiate statin therapy for primary
ally starts when you are very young associated with recurrence were prevention are uncertain , the 2019
insufficient control of conventional ACC/AHA guidelines state that it
.Before the teen years, the blood is reasonable to use coronary artery
vessel wall start to show streaks of risk factors( such as DIABETES , calcium assessment by non contrast
HYPERTENSION , AND SMOK- computed tomography (CT) to
fat. As a plaque deposits in your refine the risk estimation as a shared
blood vessel or artery’s inner wall, ING ) Multivessel disease , Asian decision – making tool. While
or sub – Saharan African ethnicity
your body fights back against the
ongoing process by sending white and inflammatory disease. Smoking

coronary artery calcium imaging is

generally not typically performed in

The consequence of premature coronary young adult age <40 years , studies
have shown that the presence of

artery disease are devastating. Although coronary artery calcium ranged from
atherosclerotic cardiovascular disease 10 % to 34 % in young adults and
events have been declining in older carried a significant increased risk
for future cardiovascular and all-

adults these gains have not extended to cause mortality .

younger adults. Coronary CT angiography is

>>>

JANUARY - MARCH, 2022|CARING HEARTS|11

Coverstory risk plaques , and obstructive CAD preventing lifestyle modifications
all correlated with an increased risk and Pharmacotherapies ( Eg:- Statin
>>> of future MACE and mortality . , aspirin , antihypetensive therapy
these findings have been extended ….etc ).
currently not endorsed as a deci- to patients at low estimated 10 year
sion aide in asymptomatic adults. risk , those without conventional risk Breaking the cycle of CAD in young
However, as a noninvasive strategy adults is going to take a multi-
it does provide a potential role to factors an younger adults <45 years . pronged approach . this approach
guide prevention recommendations perhaps most importantly demonstra- involves recognizing young adults
tion of atherosclerosis by coronary at risk to improve targets and ad-
in younger adults . in prior studies CT Angiography has been associated herence to established prevention
of symptomatic middle to older with increased implementation of approaches . further opportunities
aged adults undergoing Coronary remain to enhance personalized
CT Angiography the presence of medicine through emerging novel
no obstructive , noncalcified high multimodality imaging , inflam-
matory biomarkers , refinement of
polygenic risk score and improved
lifetime risk calculation . let us also
learn from the lessons that the young
adults with early onset of CAD from
the AFIJI study have taught us about
lesions and factors associated with
progression so that we can better
ensure history does not repeat itself
does not repeat itself for the next
generation of young adults .

Changing your diet could add up to a
decade to life expectancy, study finds

Ayoung adult could add more than a decade to For young adults, the model estimates that a sustained
their life expectancy by changing their diet change from a typical Western diet to the optimal diet
from a typical Western diet to an optimized diet that beginning at age 20 would increase LE by more than a
includes more legumes, whole grains and nuts, and decade for women and men . The largest gains in years
less red and processed meat, according to a new study of LE would be made by eating more legumes,more
publishing recently in PLOS Medicine by Lars Fadnes whole grains, and more nuts less red meat and less
of the University of Bergen, Norway, and colleagues. processed meat. Changing from a typical diet to the opti-
For older people, the anticipated gains to life expec- mized diet at age 60 years could still increase LE by 8.0
tancy from such dietary changes would be smaller but years for women and 8.8) years for men, and 80-year-
still substantial. olds could gain 3.4 years from such dietary changes.

Food is fundamental for health and, globally, “Understanding the relative health potential of dif-
dietary risk factors are estimated to lead to 11 million ferent food groups could enable people to make feasible
deaths and 255 million disability-adjusted life-years and significant health gains,” the authors say. Fadnes
annually. In the new study, researchers used exist- adds, “Research until now has shown health benefits
ing meta-analyses and data from the Global Burden associated with separate food groups or specific diet pat-
of Diseases study to build a model that enables the terns but given limited information on the health impact
instant estimation of the effect on life expectancy (LE) of other diet changes.”
of a range of dietary changes.

12|CARING HEARTS|JANUARY - MARCH, 2022

HCFarchives

JANUARY - MARCH, 2022|CARING HEARTS|13

Coverstory

New era of Sudden death of
Conjuring the healthy young
DEATHS adult is uncommon,
IN YOUNG but receives sub-
An autopsy-based series, stantial attention of
using active surveillance of media and raises a
patients in a defined popula- lot of issues . Sud-
tion, found that sudden unexplained den death in people
younger than 35,
CARDIAC death (SUD) is the most often due to undis-
covered heart de-
common cause of death among fects or overlooked
heart abnormali-
patients < 35 years of age. In India, ties, is rare.

SCD contributes to 10.3% of overall symptoms, or occurring in patients
found dead within 24 h of being as-
mortality. It involves younger popula- ymptomatic and presumably due to a
cardiac arrhythmia or hemodynamic
tion with a high prevalence of major catastrophe.

risk factors for CAD. When these Is there any difference between
Sudden Cardiac death(SCD) and
sudden deaths occur, it’s often during Sudden cardiac arrest(SCA)?

Dr. Thurdeep Sagar physical activity.More often occurs in Sudden cardiac arrest (SCA) is
Consultant Cardiologist males than in females. SCD in India defined as the “sudden cessation of
Apollo Adlux, Angamaly is a public health problem of progres- cardiac activity so that the victim be-
sively increasing magnitude which is comes unresponsive, with no normal
breathing and no signs of circula-
characterized by paucity of data. tion(absence of pulse).” If corrective
measures are not taken rapidly, this
What is sudden cardiac death condition progresses to SCD
(SCD)?
How common is sudden cardiac
Sudden and unexpected death occur- death in young people?
ring within an hour of the onset of
SCA and its most common conse-
quence, SCD, constitute major pub-

14|CARING HEARTS|JANUARY - MARCH, 2022

lic health problems, accounting for Some specific causes of sudden cardi- occur in anyone, occurs as the result

approximately 50% of all cardiovas- ac death in young people include: of a blunt blow to the chest, such

cular deathswith at least 25% being • Hypertrophic cardiomyopathy as being hit by a hockey puck or
first symptomatic cardiac event.The another player. The blow to the chest
(HCM). In this usually inherited can trigger ventricular fibrillation if
number of sudden deaths per year the blow strikes at exactly the wrong
condition, the walls of the heart time in the heart’s electrical cycle.
could exceed 700,000 and involve
muscle thicken. The thickened Are there symptoms or red flags
relatively younger, economically signs which parents, coaches and
muscle can disrupt the heart’s
productive sections of the population electrical system, leading to fast or
during coming years.
irregular heartbeats (arrhythmias),

What are the specific events which can lead to sudden cardiac others should be on lookout in a

leading to sudden cardiac death in death. young person that signals high

young? Hypertrophic cardiomyopathy, al- risk of sudden cardiac death?

SCD/SUD commonly occurs during though not usually fatal, is the most Many times these deaths occur with

exertional activities. Analysis of common cause of heart-related sud- no warning, indications to watch for

specific activities during exertional den death in people under 30. It’s the include:

sudden cardiac death showed that most common identifiable cause of • Unexplained fainting/giddiness/
recreational activities/sports was sudden death in athletes. HCM often visual blackouts during physical
most common event as compared to goes undetected. activities
organised physical training as the
major event at the time of death. • Coronary artery abnormalities. • Shortness of breath during physi-
Sometimes people are born with cal activities
Why recreational activities more heart arteries (coronary arteries)
chance to have SCD? that are connected abnormally. The • Exertional Chest pain and dis-
arteries can become compressed comfort
These recreational activities are during exercise and not provide
associated with sudden increase in proper blood flow to the heart. Does family history of SCD/SUD
HEART BEAT leading on to arryth- carry importance in preventing SCD
mias and precipitation of HEART • Long QT syndrome. This inherited in young?

ATTACKS . heart rhythm disorder can cause Family history of sudden cardiac

While an organised physical training fast, chaotic heartbeats, often death is an important signal for
helps your heart to regulate its elec- leading to fainting. Young people parents coaches and others to help
tromechanical activities alongside with long QT syndrome have an prevent sudden cardiac death in
withstand the stress and strain during increased risk of sudden death. young.

exertion thus preventing arrythmias Other causes of sudden cardiac death So family history of unexplained

and heart attacks. in young people include structural deaths before the age of 50. If this

What can cause sudden cardiac abnormalities of the heart, such as un- has occurred in your family, talk
death in young people?
detected heart disease that was present with your doctor about screening
The causes of sudden cardiac death
in young people vary. at birth (congenital) and heart muscle options.

abnormalities. What are the major modifiable risk

Other causes include inflammation of factors of CAD in young that can

the heart muscle, which can be caused prevent SCD?

by viruses(COVID -19) and other A large prevalence of risk factors for
illnesses. Besides long QT syndrome, Coronary artery disease(CAD) as
other abnormalities of the heart’s 80% of the hypertension, diabetes or
electrical system, such as Brugada smoking are considered as modifi-
syndrome, can cause sudden death. able risk factors .

Commotio cordis, another rare cause >>>
of sudden cardiac death that can

JANUARY - MARCH, 2022|CARING HEARTS|15

Coverstory There’s debate cian.
in the medical Who should be screened for
Are we able to identify and save community about sudden death risk factors?
life of these group of young pa- screening young There’s debate in the medical
tients? athletes to attempt community about screening young
to identify those at athletes to attempt to identify those
No,Only 38% were adjudicated high risk of sudden at high risk of sudden death. Some
to have definite CAD and a small death countries screen young people with
percentage underwent angioplasty an electrocardiogram (ECG), which
procedures. These facts lead us to If you’re at high risk of sudden car- records the electrical signals in the
infer that a large burden of uneval- diac death, your doctor will usually heart, Echo cardiogram(2D echo),
uated or sub clinical ischemic heart suggest that you avoid competitive if needed Tread Mill Test(TMT) is a
disease in the community predomi- sports. Depending on your underlying routine.
nantly contributes to SCD. condition, medical or surgical treat- Also in young asymptomatic cases
ments might be appropriate to reduce with family history of SCD with
In these patients SCD may be the your risk of sudden death. CAD these screening programs are
first clinical presentation. This hy- helpful.
pothesis is strengthened by the fact Modifiable risk factors can be modi-
that 35% of patients had symptoms fied treated and with a regular follow Electrocardiogram(ECG)
suggestive of HEART ATTACKS up treatment from from your physi-
and 50% of them had documented
Myocardial infarction(MI) preceding
the SCD.

Data supporting the existence of
undiagnosed significant CAD in
young patients with SCD is found
in a recent autopsy supported study
which found the presence of severe
coronary stenosis in 80% .

Can sudden death in young people
be prevented?

Implantable Cardioverter Defibrillator (ICD Electrocardiogram(ECG)

16|CARING HEARTS|JANUARY - MARCH, 2022 ICD is a pager-sized device im-
planted in your chest like a pace-
maker continuously monitors your
heartbeat.

If a life-threatening arrhythmia
occurs, the ICD delivers electrical
shocks to restore a normal heart
rhythm.

“Another option for some, such as
those with hypertrophic cardiomyop-
athy, is an ICD”

There are drugs

used to prevent

thrombosis (CLOT

LYSIS) are called

anticoagulants that

can be used as per

Tredmill Test(TMT) advise from treat- Study suggests
ing physician for at Young women
However, they might help iden- least 6 months after to focus on their
tify some who are at increased COVID -19 heart health
risk. For anyone with a family before getting
history or risk factors for con- bosis can happen in blood vessels of pregnant
ditions that cause SCD, further heart(coronaries) and will precipitate
screening is recommended. Poor heart health put ex-
pectant young mothers and
Repeat screening of family members sudden MI leading on to SCD. their babies at risk, with heart
is recommended over time, even if Can we prevent SCD in COVID disease, was causing more than
the first heart evaluation was normal. and Post COVID patients? one in four pregnancy-related
deaths.A new Northwestern
Should young people with a heart As per recent studies and data early Medicine study shined a spot-
defect avoid physical activity? diagnosis and treatment of COVID light on an important but often
-19 with adequate rest and recom- overlooked matter of the heart
If you’re at risk of sudden cardiac mended physical activity under the -- optimising one’s cardio-
death, talk to your doctor about guidance of treating physician can vascular health before getting
physical activity. Whether you can prevent such catastrophic events in pregnant.
participate in exercise or sports these group of patients.Post COVID
depends on your condition. patients are at increased risk of this Pregnancy stresses a woman’s
thrombosis in first 6 months period heart and circulatory system.
For some disorders, such as hyper- after COVID-19 infection. During pregnancy, a lady’s
trophic cardiomyopathy, it’s often blood volume increases by 30
recommended that you avoid most There are drugs used to prevent to 50 per cent to nourish her
competitive sports and that if you thrombosis (CLOT LYSIS) are called growing baby.
have an ICD, you should avoid anticoagulants that can be used as per
impact sports. But this doesn’t mean advise from treating physician for at The study was published in
you need to avoid exercise. Talk to least 6 months after COVID -19 . ‘Circulation’, the American
your doctor about restrictions on Heart Association’s (AHA)
your activity. Conquering the conjuring effects of peer-reviewed flagship journal,
SCD/SUD is a massive task in front as part of a themed issue for
Is COVID -19 a major risk factor of medical community. Medical and the Go Red for Women Cam-
for SCD in young india? social worker awareness regarding the paign that was developed by
modifiable and non modifiable risk the AHA in 2004 to highlight
COVID -19 has taken away lot of factors can evade us from these cata- awareness about heart disease
precious life including some young strophic events. Young India needs to risks in women.
hardworking medical health care be aware of these conjuring deaths.
providers.Corona virus infection Early diagnosis and promote prevent- JANUARY - MARCH, 2022|CARING HEARTS|17
can precipitate a cascade of events ing measures can help us to save these
in our immune system rendering precious life for us to have a better
us for increased chances of CLOT tomorrow.
formation(thrombosis).This throm-

Dieticiansexclusive

Healthy
Lifestyle
changes

for Youth

Dr Nisha Vikraman The youth of today have a where it’s 37.9% of men and 41.5%
Assistant Professor different study and work of women. A huge part of why
Department Of Home Science culture which is not allow- Japanese people live so long and
St. Theresa’s College, ing for energy utilisation as it was why they beat most countries with
Ernakulum two years back. They are confined regards to health is their diet.
to chairs working or studying long
18|CARING HEARTS|JANUARY - MARCH, 2022 hours in front of computer and doing Through easy solutions in our diet
online activities. This is a threat to and lifestyle we can have a con-
their health as the sedentary lifestyle trol and maintain healthy lifestyle
would lead to more obesity, stress and practices.
lifestyle diseases.
Healthy food and life style practic-
Our youth can learn some lessons es to be incorporated by the youth
from our Asian neighbouring country
1. Variety of food items to enhance
Japan. Inspite of technological immunity
advancements they maintained huge
responsibility towards maintaining Increasing immunity is the new
health by monitoring their lifestyle. obsession. To keep our immuni-
According to the World Health Or- ty high, health specialists have
ganization, Japanese people have the recommended different types of
highest life expectancy in the world: immunity boosters.We have to
83.7 years. They also have one of the replace the supplements like Zinc
lowest obesity rates. In Japan, only and Vitamins and adding foods
3.8% of men and 3.4% of women are that are high in vitamins/proteins/
obese compared to the United States zinc, etc. Some foods rich in zinc
are nuts, beans, bananas, oys-
ters, whole grains, dairy foods

like cheese, and many more. The World Health Organization recom-
Food rich in vitamin C is- ama- mends less than 5% of calories from add-
la, guava, grapefruit, oranges, ed sugar for optimal health. Thedrinks
broccoli, potatoes, peppers, and that many people perceive as healthy,
many more. The benefits are in such as smoothies and fruit juices, can
their natural forms which are also still contain astounding amounts of added
cheaper and effective. sugar.

2. Avoiding sugary and processed and hungry and make us crave ness we gather actually comes
products:
more sugar. Grain- and dairy- into practice.
The World Health Organization
recommends less than 5% of based desserts, such as cakes, pies, There is also an emotion involved
calories from added sugar for op- doughnuts, and ice cream, account
timal health. Thedrinks that many in homemade foods which helps
people perceive as healthy, such for more than 18% of the intake
as smoothies and fruit juices, can to connect to childhood memories
still contain astounding amounts of added sugar in the diet. If we
of added sugar. For example, 1 and has a de-stressing effect.Ac-
cup (271 grams) of cranberry have something lower in added
juice cocktail contains more than cording to a study by scientists at
7 teaspoons of sugar (31 grams). sugar that can still satisfy our sweet Ohio State University, you crave
tooth, the alternatives are
Our body doesn’t recognize unhealthy snacks more when
calories from drinks in the same • fresh fruit
way as those from food. Calories they’re within your reach.
from drinks are absorbed quickly, • Greek yogurt with cinnamon or
resulting in a rapid increase in fruit 4. Eat fiber
our blood sugar level.Drinks also
don’t make us feel as full as solid • baked fruit with cream Soluble fiber helps feed help-
food, so people who consume lots
of calories from drinks don’t eat • dark chocolate (70% cocoa or ful bacteria in your gut, which
less to compensate Reducing our
intake of sugary drinks can help higher) decreases inflammation and
with weight loss and improve
overall health. A bonus of eating whole fruit is helps prevent obesity. We rely

Here are some healthier beverage swapping sugar-heavy desserts on carbohydrates for energy, and
options that are naturally low in
sugar: for fresh or baked fruit not only fiber has been shown to help

• water reduces our sugar intake but also digest those carbohydrates more
• unsweetened sparkling water
• herbal teas increases the fibre, vitamins, min- efficiently. Adding soluble fiber to
• black or green tea
• black coffee erals, and antioxidants in your diet. your diet will also help you feel
fuller longer.
Most desserts also don’t provide 3. Cooking and eating fresh home-
much in the way of nutritional 5. Eating only at the dining table
value. They’re loaded with sugar, made traditional foods
which causes blood sugar spikes without any distraction.
that can leave us feeling tired Learning to cook and eating home-
made food along with avoiding It’s very important to respect food
processed food not only will helpto by giving an undivided attention
lose weight faster, age slower, get to food alone while eating. This is
less headaches and have better hair, healthy practice among Japanese
skin and brain function. Cooking at people that the food is only served
home gives a more conscious use and eaten on the dining table.In
of healthy ingredients and process- Japan, people sit down at a dining
ing of food items ideal to the diet table because eating is an expe-
needed. Also more awareness and rience that they believe should
involvement in the food we add to have their full attention. As such,

our diet. All the nutritional aware- >>>

JANUARY - MARCH, 2022|CARING HEARTS|19

Dieticiansexclusive more cases of obesity. Borderline metabolism, whereas in women,
diabetes and hypertension among an increased breakdown of car-
it’s traditional for the Japanese to the youth. bohydrates caused the increase in
enjoy their meals. It was also our metabolism .
tradition we need to revive it. 8. Stop counting calories count the
quality of food The researchers estimate that over
6. Incorporating fresh fruits and the course of a year, a person who
vegetables. Nutritionists recommend that you increases his water consumption
stop focusing on calories and pay by 1.5 liters a day would burn
The Japanese diet is low in more attention to the quality of an extra 17,400 calories, for a
saturated fats and salt, processed the products you eat since not all weight loss of approximately five
foods, sweets, and drinks that calories are equal.It’s the quality of pounds. They note that up to 40%
contain a lot of sugar. On a regular the food you eat -- not the calories of the increase in calorie burning
day, a person should consume 5 in that food -- that determines what is caused by the body’s attempt to
to 7 grain dishes (like rice, bread, eating it will do to your metabolism heat the ingested water. The find-
noodles, and pasta), 5 to 6 vegeta- and absorption of nutrients. ings are reported in the December
ble dishes of different varieties, 3 issue of The Journal of Clinical
to 5 fish and meat dishes, 2 milk Real, natural foods with fiber, pro- Endocrinology and Metabolism.
products (like milk and cheese), tein, and fat are so satisfying, you’ll
and 2 fruits. Our diet should place naturally eat less of them, the new 10. Exercise for average 30 min-
a focus on buying locally sourced thinking goes. “If the meal contains utes with the 2 1/2-minute rule
foods and seasonalfoods. all three, then the food will move
more slowly through the GI tract,” 5–30 seconds of hard exercise
7. Eating small balanced meal says Mira Ilic, a clinical dietitian during a workout (for example,
portions more often rather than at Cleveland Clinic. When a food speeding up while riding a bike
large three meals takes its time passing through the or running on a treadmill) with
body, you feel fuller longer. 4-minute breaks may increase
When you eat frequently, you let your metabolism, and you’ll burn
your body know that there’s no Instead of choosing a meal based on an extra 200 calories.
need to accumulate fats. When we calories, we need to picking foods
skip a meal, we send the opposite from all three categories: one high 11. No day time napping
signal — and we tend to eat more. in fiber, like a vegetable or whole
grain; a protein source (think: Studies have shown that people
Many studies suggest that eating chicken or salmon); and a healthy who napped during the daytime
more frequently may offer benefits fat, like a salad with olive oil and for more than 1 h were inde-
by decreasing hunger and food chopped avocado. pendently associated with a great-
intake at subsequent meals. One er prevalence of diabetes.Those
study involving close to 2,700 9. Drinking more water who napped during the daytime
women and men found that those within a half hour showed a lower
who ate at least six times per day Water is the key to life, and it turns prevalence of fatty liver, dyslipid-
ate fewer calories, consumed out it’s also one of the easiest ways emia, and central obesity.
healthier foods and had a lower to help your metabolism. Drinking
body mass index than those who water increases your metabolism by Studies show that while power
ate fewer than four times over up to 25% for nearly an hour after naps (taking a 20-minute nap)
a 24-hour period. Research has drinking it. That means if you drink can be beneficial, longer naps
also shown that increased meal a few cups of water every hour, say taking 2-hour naps every day,
frequency has positive effects on you’ll keep your metabolism at can adversely affect your sleep.
cholesterol and insulin levels. peak performance all day. It can confuse your internal clock
which is why many people com-
But while eating small frequent Studies also showed that the in- plain “when I take a nap I can’t
meals can discourage large swings crease in metabolic rate differed in sleep at night”. According to one
in blood sugar, decrease hunger men and women. In men, burning study, sleep participants reported
and prevent impulsive snack- more fat fueledhelps to increase
ing throughout the day. We see

20|CARING HEARTS|JANUARY - MARCH, 2022

One study found that peo-
ple who went to bed late
and didn’t get a full night’s
sleep consumed more calo-
ries, fast food, and soda and
fewer fruits and vegetables
than those who went to bed
earlier and got a full night’s
sleep.

that instead of feeling fresh and also help you get rid of unwanted - Science proves that people burn
recharged, they experienced the belly fat. less fat when they sleep during the
feeling of lethargy after taking day and are active at night.
long daytime naps. Yet another One study found that people who
study showed that while naps that went to bed late and didn’t get a full 14. Avoiding blue light
lasted between 20 to 30 minutes night’s sleep consumed more calo-
and not a minute more, enhanced ries, fast food, and soda and fewer Anthropology at Kyushu Uni-
cognitive functioning of the brain, fruits and vegetables than those versity showed that bright light
naps that were longer resulted in who went to bed earlier and got a confuses our brain, which then
poor sleep quality and interrupted full night’s sleep. stops producing melatonin. Our
night-time sleep. 13. Keep the room/house effectively metabolism is tightly connected
ventilated to our sleeping patterns and the
Short daytime napping duration Good ventilation systems arehav- amount and quality of our sleep.
is associate with reduced rate of ing positive impact on health and
metabolism-related diseases and well-being. Indoor air pollution We can see lot of late night and
may protects people from nega- coupled with bad ventilation can device addiction among the youth
tive health conditions, whereas lead to a number of health problems nowadays. This directly affects
long daytime napping duration is including headaches, allergies, the sleeping pattern and disrupts
associate with higher prevalence asthma, rashes and sinusitis. the metabolism leading to various
of diabetes, which then can be complications
harmful for health. We must make sure there is an
adequate supply of fresh air in any Healthy living is an essential com-
12. Eight hours of sleep workspace and home. We can do ponent to living and breathing.
this by using natural ventilation Making good decisions on what
Good sleep habits are incredibly (fresh air comes in through open you eat, drink, how often you ex-
important for our health. Poor windows, doors or air vents). This ercise and whether you wear your
sleep has been linked to depres- is also known as ‘passive air flow’ seatbelt when you drive ultimately
sion, poor concentration, reduced and mechanical ventilation (fans affects your healthy living bubble.
immune function, and obesity. and ducts bring in fresh air from It is a very broad category, and
However, lack of sleep may also outside). there are a ton of things that fall
affect the types of food we eat, under it. It is important that youth
predisposing our choicesto higher Cool temperatures in a room understand what healthy living
in sugar, fat, salt, and calories.A influence brown fat (a fat layer that is all about so that they get into a
healthy 8 hours of sleep (from 10 protects the body from freezing). As habit of making sound decisions
PM/11 PM to 6 AM/7 AM) con- a result, it splits white fat and burns when it comes to choices sur-
tributes to great metabolism. It can chemical energy to create heat. rounding healthy living.

JANUARY - MARCH, 2022|CARING HEARTS|21

Coverstory

Exercise and
the risk of

heart attack

Dr. Blesson Varghese Heart Attack or Acute Myo- high blood pressure that can lead to
Consultant Cardiologist cardial Infarction is one of heart attack or stroke.
Welcare Hospital, the leading causes of death
Kochi among all societies in the world. A Regular exercise has a favourable ef-
sedentary lifestyle and lack of exer- fect on many of the established risk
22|CARING HEARTS|JANUARY - MARCH, 2022 cise is one of the 5 major risk factors factors for cardiovascular disease.
(along with high blood pressure, Major benefits of exercise on heart
abnormal values for blood lipids, health can be considered in two
smoking, and diabetes) for cardiovas- ways. Direct and indirect benefits.
cular disease leading to heart attack. There are a number of physiological
Studies shows that reducing these risk benefits of exercise; 2 examples are
factors decreases the chance of having improvements in muscular function
a heart attack or experiencing another and strength and improvement in
cardiac event, such as a stroke, and the body’s ability to take in and use
reduces the possibility of needing a oxygen (maximal oxygen consump-
coronary revascularization procedure tion or aerobic capacity).As one’s
(bypass surgery or coronary angio- ability to transport and use oxygen
plasty). Being physically active is a improves, regular daily activities can
major step toward good heart health. be performed with less fatigue. This
It’s one of the most effective tools is particularly important for patients
for strengthening the heart muscle, with cardiovascular disease, whose
keeping weight under control and exercise capacity is typically lower
warding off the artery damage from than that of healthy individuals.
high cholesterol, high blood sugar and Patients with newly diagnosed heart
disease who participate in an exer-

cise program report an earlier return tensive patients. Exercise causes dila- activity that is dynamic in nature and
to work and improvements in other tion of the arteries thereby decreasing of similar intensity, such as brisk
measures of quality of life, such as the blood pressure. Although vigorous walking, cycling and swimming.
more self-confidence, lower stress, high intensity exercise can sometimes This amount of exercise equates to
and less anxiety. Studies have found increase the heart rate and blood pres- approximately 600 to 1200 calories
that for heart attack patients who sure, regular exercise brings down the expended per week. Many of the
participated in a formal exercise pro- blood pressure as a long term effect. studies documenting the benefits of
gram, the death rate is reduced by There is also evidence that exercise exercise typically use programs con-
20% to 25%. This is strong evidence training improves the capacity of the sisting of 30 to 60 minutes of contin-
in support of physical activity for blood vessels to dilate in response to uous exercise 3 -5 days per week at
patients with heart disease exercise or hormones, consistent with an intensity corresponding to 60% to
better vascular wall function and an 75% of the individual’s target heart
Indirect benefits are mainly by improved ability to provide oxygen to rate. Target heart rate is calculated
preventing or delaying the onset the muscles during exercise. Although by subtracting persons age from 220
and progression of other risk factors the effect of an exercise program on (THR= 220-Age). High intensity
which are closely linked to the de- any single risk factor may generally work outs results in rise upto 85%
velopment of heart attack. Diabetes be small, the effect of continued, of target heart rate. One need not be
Mellitus, by itself is a coronary moderate exercise on overall cardio- a marathon runner or an elite athlete
equivalent, makes the person 4 times vascular risk, when combined with to derive significant benefits from
higher risk of contracting an acute other lifestyle modifications can be physical activity, the greatest gains
coronary event. Regular exercise, by dramatic. in terms of mortality are achieved
increasing the insulin sensitivity de- when an individual goes from being
lays the onset of diabetes and helps How much exercise is enough for sedentary to becoming moderately
to reduce the blood sugar levels in keeping heart healthy? The gener- active.
patients with established diabetes. al agreement among all scientific
Exercise can reduce “bad” cholester- societies is the minimum 30 minutes It’s also true that different types
ol levels in the blood (the low-densi- of moderate intensity exercise at least of exercise are needed to provide
ty lipoprotein [LDL] level), as well 5 days of a week or preferably most complete fitness. Aerobic exercise
as total cholesterol, and can raise the days of the week. Modest activity is and resistance training are the most
“good” cholesterol (the high-density defined as any activity that is similar important for heart health. Aerobic
lipoprotein level [HDL]). Exercise in intensity to brisk walking at a rate exercise is defined as using aero-
also reduces triglycerides. Exercise of about 4 to 5 kilometers per hour. bic metabolism to extract energy
promotes weight reduction and can These activities can include any in muscles, mainly referring to
help reduce blood pressure in hyper- form of occupational or recreational
>>>

How much exercise is enough for keeping
heart healthy? The general agreement
among all scientific societies is the mini-
mum 30 minutes of moderate intensity ex-
ercise at least 5 days of a week or prefera-
bly most days of the week. Modest activity
is defined as any activity that is similar
in intensity to brisk walking at a rate of
about 4 to 5 kilometers per hour

JANUARY - MARCH, 2022|CARING HEARTS|23

Coverstory

low- to moderate-intensity physical resistance training as age progresses. who exercises about 5 times per
activities. Brisk walking, running, week. In simple terms individuals
swimming, cycling, playing tennis High-intensity interval training (HIIT) who exercise regularly are much less
and jumping rope are examples of shows more beneficial effects on the likely to experience a heart attack
aerobic activities. Aerobic exercise cardiovascular system compared to during exercise. Moreover, contrary
improves circulation, which results low-intensity training. The advantages to popular view, the majority of
in lowered blood pressure and heart of high-intensity intermittent exercise heart attacks (approximately 90%)
rate. In contrast, anaerobic exercise refer to the fact that the shorter time occur in the resting state, not during
usually refers to high-intensity train- as 3-4 sessions/week will produce physical activity. Nevertheless, it
ing, including sprinting and power significant changes. However, there is a good idea to be aware of the
lifting. In several studies, high-in- is an elevated mortality and sudden warning signs or symptoms that may
tensity exercise is recommended to death brought by high-intensity activ- indicate an underlying heart disease:
lower TG and LDL. Similar to aero- ity rarely. An acute strenuous exercise chest discomfort (pain or pressure
bic exercise, anaerobic exercise also ion an unaccustomed person increases in the chestpossibly radiating into
shows positive influences on body the risks for MI and sudden cardiac the shoulder, arm, jaw or back),
mass index and blood pressure. Re- death unusual shortness of breath, dizzi-
search shows that a combination of ness or light-headedness, and heart
aerobic exercise and resistance work During exercise, there is a transient rhythm abnormalities (sensations of
may help raise HDL (good) choles- increase in the risk of having a cardi- heart beat skipping, palpitations, or
terol and lower LDL (bad) choles- ac-related complication (for exam- thumping). If one of these symptoms
terol. At least two nonconsecutive ple, a heart attack or serious heart occurs during exercise, exercise
days per week of resistance training rhythm disorder). However, this risk should be discontinued and medical
is a good rule of thumb, according is extremely small. For adults without attention should be sought immedi-
to the American College of Sports existing heart disease, the risk of a ately. People who have diagnosed
Medicine. Flexibility workouts, such cardiac event or complication ranges heart disease or are over 45 years of
as stretching or yoga, don’t directly between 1 in 400 000–800 000 hours age and have multiple risk factors
contribute to heart health. What they of exercise. For patients with existing like diabetes, hypertension, obesity
do is benefit musculoskeletal health, heart disease, an event can occur an etc should consult a physician before
which enables you to stay flexible average of once in 62 000 hours. Im- starting any type of exercise.
and free from joint pain, cramping portantly, the risk of a cardiac event
and other muscular issues. That flex- is significantly lower among regular Clearly the benefits of exercise far
ibility is a critical part of being able exercisers. Evidence suggests that a exceeds the risk of a heart attack
to maintain aerobic exercise and sedentary person’s risk is nearly 50 during exercise.
times higher than the risk for a person

24|CARING HEARTS|JANUARY - MARCH, 2022

Having
a good
listener

improves your

brain health “Loneliness is one of
the many symptoms

Supportive social interactions in of depression, and has
adulthood are important for your other health implica-
ability to stave off cognitive decline
tions for patients”

despite brain aging or neuropatho-

logical changes such as those present people can take steps, either for them- lost a lot of time decades before to

in Alzheimer’s disease, a new study selves or the people they care about build and sustain brain-healthy hab-

finds. most, to increase the odds they’ll slow its,” says Salinas. “But today, right

In the study published JAMA Net- down cognitive aging or prevent the now, you can ask yourself if you tru-

work Open, researchers observed development of symptoms of Alzhei- ly have someone available to listen

that simply having someone avail- mer’s disease - something that is all to you in a supportive way, and ask

able most or all of the time whom the more important given that we still your loved ones the same. Taking

you can count on to listen to you don’t have a cure for the disease.” that simple action sets the process

when you need to talk is associated An estimated 5 million Americans in motion for you to ultimately have
with greater cognitive resilience - are living with Alzheimer’s disease, better odds of long-term brain health
a measure of your brain’s ability a progressive condition that affects and the best quality of life you can
to function better than would be mostly those over 65 and interferes have.”

expected for the amount of physical with memory, language, deci- Salinas also recommends that

aging- or disease-related changes in sion-making, and the ability to live physicians consider adding this

the brain, which many neurologists independently. Salinas says that while question to the standard social his-

believe can be boosted by engaging the disease usually affects an older tory portion of a patient interview:

in mentally stimulating activities, population, the results of this study asking patients whether they have

physical exercise, and positive social indicate that people younger than 65 access to someone they can count

interactions. would benefit from taking stock of on to listen to them when they need

“We think of cognitive resilience as their social support. For every unit of to talk. “Loneliness is one of the

a buffer to the effects of brain aging decline in brain volume, individuals many symptoms of depression, and

and disease,” says lead researcher in their 40s and 50s with low listener has other health implications for pa-

Joel Salinas, MD, the Lulu P. and availability had a cognitive age that tients,” says Salinas. “These kinds of

David J. Levidow Assistant Profes- was four years older than those with questions about a person’s social re-

sor of Neurology at NYU Grossman high listener availability. lationships and feelings of loneliness

School of Medicine and member of “These four years can be incredibly can tell you a lot about a patient’s
the Department of Neurology’s Cen- precious. Too often we think about broader social circumstances, their
ter for Cognitive Neurology. “This how to protect our brain health when future health, and how they’re really
study adds to growing evidence that we’re much older, after we’ve already doing outside of the clinic.

JANUARY - MARCH, 2022|CARING HEARTS|25

Coverstory

NEW GEN LIFESTYLE

AND HEART
DISEASE

Dr Abhilash T G MD DM the heart). Cardiovascular disease in disease
Consultant Interventional Indians occurs a decade earlier than in
Cardiologist the Western population. For Indians, Although there are some nonmod-
Travancore Medical College, particular causes of concern in CVD ifiable risk factors for the devel-
Kollam are early age of onset, rapid progres- opment of cardiovascular disease
sion, and high mortality rate. like increasing age, male sex,
Cardiovascular diseases menopause in females, and family
(CVD) and stroke are the In this article, we discuss the risk history of heart disease (first-degree
leading causes of mortality factors for cardiovascular disease, the relative before age 55 in males or
worldwide. Cardiovascular diseases impact of the new generation lifestyle 65 females) majority of risk factors
include coronary artery disease (dis- on cardiovascular diseases, and ways are modifiable. Major modifiable
ease of blood vessels of the heart), to prevent Cardiovascular disease. risk factors for heart disease are
Cerebrovascular disease (disease of smoking, dyslipidemia, hyperten-
the blood vessels of the brain mani- Concerns regarding new-gen lifestyle sion, diabetes, abdominal obesity,
festing as Stroke), Peripheral arterial include sedentary lifestyle, increasing psychosocial factors, and decreased
disease (disease of the blood vessels body weight, increased consumption consumption of fruits and vegeta-
of limbs), and Aortic diseases (dis- of high calorie processed foods and bles.
ease of the main blood vessel from refined sugars, high-stress level, in-
creasing use of tobacco, alcohol, and Diabetes, Hypertension, and
use of illicit drugs. All of these are Dyslipidemia
associated with an increased risk for
cardiovascular disease. Hypertension is considered a silent
killer as it is associated with stroke,
We have to understand that although heart attack, and kidney disease. 50-
cardiovascular disease events gen- 60% of people are unaware of their
erally manifest in adulthood, the hypertension, less than half starts
atherosclerotic process begins in early treatment and only half of them have
adolescence. their BP under control.

Risk factors for cardiovascular Diabetes is considered a ‘Coronary

26|CARING HEARTS|JANUARY - MARCH, 2022

artery disease Equivalent’ because It has a variety of beneficial effects to the early development of ath-

of the increased risk of getting heart including an elevation in serum erosclerosis as well as to the acute

attacks. Diabetics have an earlier HDL cholesterol, reduction of serum precipitation of MI and sudden

onset of disease, more extensive dis- triglycerides, reduction in blood cardiac death. Stress also leads to

ease, an increased risk of silent heart pressure, less insulin resistance, and an aggravation of traditional risk

attacks, and increased mortality after weight loss. factors such as smoking, hyperten-

getting a heart attack. Our younger generation, because sion, and deranged lipid metabolism.
of their busy schedules, increased Depression, anger, stress, and other
Abnormal levels of cholesterol as- availability of individual vehicles, factors have been correlated with
sociated with increased risk of CVD and increased screen time has little or poor cardiovascular outcomes.
include-High total cholesterol, high

low-density lipoprotein cholesterol no time to exercise. It is very import- The vicious cycle of highly stressful

(LDL-C), low high-density lipopro- ant to have at least 150 minutes of competitive lifestyle and resorting

tein cholesterol (HDL-C), and high moderate-intensity aerobic activity in to unhealthy practices like smoking,

triglycerides (TG). a week. binging, use of illicit drugs as stress

It is important to detect these risk Obesity — Although the western busters increase the risk of heart
factors early by periodic testing cut-off for obesity is BMI greater than disease. It is important to come out
because early detection and proper 30, a lower cut-off of 25 is suggested of this dangerous loop to decrease
treatment of these risk factors can for Indians. Obesity is associated with stress at home and the workplace
prevent or delay the onset of heart several risk factors for heart dis- and to find healthy stress busters.

disease. ease including hypertension, insulin Recreational drugs and heart

Lifestyle risk factors resistance and glucose intolerance, Most of the illegal drugs can have
hypertriglyceridemia, and reduced adverse cardiovascular effects,
Cigarette smoking — The incidence HDL cholesterol. ranging from abnormal heart rate to
of a heart attack is increased sixfold heart attacks. Injecting illegal drugs
in women and threefold in men Lack of exercise, increased consump- can lead to bacterial infections of
who smoke at least 20 cigarettes per tion of high-calorie diets and sugars, the blood vessels and heart valves.
day compared with subjects who increased screen time, etc. contribute Cocaine, amphetamine, and ecstasy
never smoked. The risk of recurrent to increasing obesity in our young can all have adverse effects on the
heart attack normalized to that of generation. The culture of regular ex- cardiovascular system. Cocaine is
non-smokers within two years of ercise should be started from a young called “the perfect heart attack drug”
smoking cessation. age. Rather than replacing play- – due to multiple factors like higher
grounds for high-rise buildings with blood pressure, stiffer arteries, and
Diet high-tech classrooms, schools should

Dietary risk factors include con- encourage physical activity in our thicker heart muscle, all of which

sumption of high glycemic index students so that the habit of regular are associated with higher risks of

foods, low consumption of fruits exercise starts from a younger age and heart attack and stroke.

and vegetables, high consumption of helps prevent CVD in adulthood. Prevention of cardiovascular dis-
red meat, high consumption of trans Psychosocial factors eases- Life’s Simple 7
fatty acids, and low consumption of Psychosocial factors may contribute
Fibre. One another important factor

is the consumption of high-calorie

processed foods and increased use of

refined sugars.

Lack of Exercise and Obesity

Exercise of even moderate degree
has a protective effect against heart
disease and all-causes of mortality.

JANUARY - MARCH, 2022|CARING HEARTS|27

Heartstudy

Is xenotransplantation

the answer to the donor
organ shortage?

Since the first successful transplantation is mainly attributed donor antigens, known as substanc-
organ transplant in 1954, to the improvement of gene-editing es that trigger the immune system.
the procedure has become techniques (such as CRISPR/Cas9), While non-human primates (NHPs)
increasingly prevalent, revolution- since genetically engineered animals are
izing the treatment of end-stage have been bred to overcome organ re-
organ failure. Nevertheless, organ jection. However, xenotransplantation phylogenetically closer to humans
shortage remains a critical problem also raises multiple biological and than pigs, the latter are regarded as
that could potentially be overcome ethical questions that should be taken a more appropriate xenograft source
by xenotransplantation, a promising into consideration. for multiple reasons. Pigs not only
alternative approach. While the field reproduce easily and have organs
of organ and cell allotransplantation Potential impacts and of comparable size to humans, they
(from a donor of the same species) developments. also present physiological similar-
remains limited, xenotransplanta- ities. For instance, porcine valve
tion (from the Greek xenos, mean- Pigs, the most suitable xenograft replacement has been successful
ing ‘foreign’) could alleviate the source. The greatest difficulty for over 30 years and is considered
increasing demand for donor organs. encountered in transplantation is a better alternative to mechanical
Xenotransplantation, defined as the rejection caused by the mounting of valves, which are more prone to
transplantation of animal-derived immune responses against the donor blood clot formation. Attempts
organs and cells into humans, is organ, perceived as a foreign threat have also been made to transplant
currently a very active focus of by the human body. Graft rejection pig kidneys, corneas and livers, but
research. can be classified as hyperacute, acute the main challenge remains that of
or chronic, depending on the time it overcoming the immune barriers to
The resurgence of interest in xeno- takes for antibodies to react against xenotransplantation. Finally, there

28|CARING HEARTS|JANUARY - MARCH, 2022

are fewer ethical and other implica- the transmission of zoonoses follow- very encouraging results. Important-
tions when working with pigs than ing xenotransplantation. The dynamic ly, one of the genes inserted plays a
with NHPs. developments in this field of research crucial role in regulating the coag-
have occurred mainly as a result of ulation system. The cells resulting
Genome editing. CRISPR/Cas9, a novel gene-editing from these genetically modified pigs
technology that has revolutionized were resistant to rejection, demon-
The implementation of potent biomedical research. It basically strating greater compatibility with
immunosuppressive regimens has consists of an enzyme (Cas9) acting humans in terms of the immune
helped to prolong xenograft survival as a pair of ‘molecular scissors’ that system as well as the blood-coag-
significantly by reducing the risk follow the ulation system. Another promising
of rejection. However, a number of achievement beyond overcoming
issues, such as coagulation dysfunc- guide RNA (gRNA) to a target rejection is the use of CRISPR/
tion between the pig-derived graft sequence in the DNA in order to intro- Cas9 technology to limit the risk
and the human, remain problematic, duce changes or make deletions. of cross-species transmission of
as certain molecular incompatibili- infectious viruses, therefore remov-
ties cannot simply be overcome by Examples of transgenic pigs ing a major hurdle to using pigs for
immunosuppression. As a result, sci- for xenotransplantation pur-

Pigs, the most

suitable xeno-

graft source. The

greatest difficulty

encountered in

transplantation is

rejection caused

by the mounting of

immune responses xenotransplantation. In an attempt
to mitigate incompatibility, various
against the donor poses. studies have so far attempted more
organ, perceived than 40 genetic modifications on the
as a foreign threat Pig-antigens are not synthesized by pig genome thanks to the devel-
by the human the human species and can cause opment of new gene editing tools.
mounting immune responses that lead This global effort has very recently
culminated in the first successful pig
body to organ rejection. It is therefore of to human xenotransplantation of a
vital importance to eliminate the pig genetically modified heart, raising
hopes that we are ‘one step closer to
entists have focused primarily on the genes responsible for encoding these solving the organ shortage crisis’.

generation of genetically modified antigens for the organ recipient. A

pigs. These not only have engi- recent study involving the inactiva-

neered organs that are less prone to tion of three such pig genes and the

rejection, but are also protected from insertion of nine human genes using

a number of viruses that could cause CRISPR/Cas9 technology generated

JANUARY - MARCH, 2022|CARING HEARTS|29

Healthyexercises

THE
NO-GYM

SIMPLE
CARDIO HOME

EXERCISES

Dr.Danny Jose (PT)
Physical Therapist

There is growing concern over and move to the next. As your fitness previous experience of physical ac-
the effects of sedentary life- increases, more repetitions can be tivities or special training to perform
styles on the health of young done. Even beginners do not require these exercises.
people. Recent rapid increases in ju-
venile obesity have received a great
deal of attention in the scientific
and popular press and have been at-
tributed partly to television viewing,
computer games and other sedentary
behaviors. These are thought to
compete with physical activity.

You don’t need a lot of equipment
for cardio vascular exercises, instead
they can be done at home. Choose
the exercise that suits your current
fitness level. These exercises can be
performed at any convenient space
other than home eg; park or outer
space. Cardio vascular exercise
has to be performed in a slow and
rhythmic manner with a warm up,
acceleration and deceleration phase.
For example you could do an exer-
cise for 1 minute, rest for 30 seconds

30|CARING HEARTS|JANUARY - MARCH, 2022

HCFnews

A report on the Cardio Pulmonary Resuscitation (CPR)-Basic life support
Awareness Session on Heart Care Foundation for Rotary Club of Tripunithura
Royale on Zoom platform- 8.00 pm Friday September 24, 2021

The Session with Rotary Club
of Tripunithura Royale went off
very well. The meeting started
with welcome address by Dr.
Jhon Mathew President, Rotary
Club of Tripunithura Royale,
The meeting was inaugurated
by Chairman HCF. This was
followed by a brief presentation
by Chairman Dr. Jose Chacko
Periappuram on HCF activities.
Dr Jacob Abraham (Trustee,
HCF) then made a detailed
session on in his usual inimita-
ble style with facts and figures.
After the session the floor was
open for Q&A. The Session was
concluded with a vote of thanks
by Dr. Jhon Mathew.

MARCHING IN PLACE works good for abdominal muscles hip apart and arms down. Raise the

Stand in one place and move your and increase intensity can be done by arm out to the side straight in the
legs up and down as if marching but
without moving forward. We can lifting the leg higher off the floor or air while jumping out with the feet
hold our hip with both hands on the
sides. To increase the intensity one jump from one leg to other. apart. Jump back in to the starting
can increase the speed of the march
and raise the knees higher. Bring JOGGING IN PLACE position and land softly on the heels.
the knees as close to your chest as The intensity of the exercise can be
possible. This exercise is suitable To perform this, bounce lightly from increased or reduced by varying the
for a single cardio activity and good one foot to other, standing in the speed of jumping.
warm up too. same position and swinging the arms
from side to side as if you are moving ARM CIRCLES
SINGLE LEG STAND
while normal jogging. This is a simple This can be performed while sitting
Place your hands on your hips on
both sides and keep your feet on the and effective exercise to increase the or standing by rotating your arms
floor about 3 inches apart. Bend the
knees slightly and lift one leg 3 to 6 heart rate. in a circle, clockwise and anti-
inches off the floor. Hold the posi-
tion for 10 to 15 seconds by count- DANCING TO MUSIC clockwise. Rotate the arms in a
ing and return to the same position circular motion, both clockwise and
and repeat on opposite leg. This You can turn any free space into a anticlockwise. The movement may
dance floor where you can do simple resemble a butterfly or a backstroke.
and easy steps listening to music. The
intensity of exercise can be increased For those with limited mobility of
by changing to upbeat music. their arms, they can extend their
arms to the sides and draw smaller
JUMPING JACKS circles on any surface.

This can be performed with the feet-

JANUARY - MARCH, 2022|CARING HEARTS|31

Dear Friend, since you are reading this I selected by an expert panel, is awarded the Heart
presume that you either are a Heart Care Care Foundation’s Lifetime Achievement Award.
Foundation member or a member friend has Another very important activity,
given this to you. Either way, you are very important to ‘Hrudayasangamam’ happens twice a year and its
this humble movement called Heart Care Foundation primary objective is the rehabilitation of patients
and we all are thankful for whatever help your who underwent heart surgery during the period.
valuable association can bring to the Foundation. Through general Q&A with senior doctors,
physiotherapists and dietitians, the patients are
Let me briefly explain to you the activities of the encouraged back in to normal life stream. Family
Foundation. Founded on the World Heart Day, members of the patients form an integral part of this
September 29, 2005 and inaugurated by the then get-together and the experience sharing as well as
Governor Sri. R.L Bhatia, HCF was able to the general Q&A with the experts helps them realize
successfully complete several projects related to heart that their loved one is no longer an invalid. Adding
care in Kerala. Our first project ‘Save 1000 hearts, charm to this social gathering is our ‘Social
1000 lives, 1000 families’ provided financial Excellence Award’ constituted in memory of our
assistance to over 1500 needy patients from all over founder member Mr. C V Shanmugam. Selected by
the state, without any discrimination in cast or creed. another expert panel, the awardeeis an eminent
The next program ‘Save a Life, Save a Lifetime’ personality that exceled in their respective field of
launched in 2007 has been a big hit among the activity.
corporate houses, schools and colleges and we have
conducted over 200 training sessions on Basic Life Yet another project is ongoing and is unique as well
Support–CPR and was instrumental in the installation as ambitious and will help a much larger populace,
of AED’s (Automated External Defibrillator) at many hopefully covering the entire state. Recently
prominent public centers. launched by Sri P.Sreeramakrishnan,Honorable
Speaker, Kerala Legislative Assembly,
Every World Heart Day is celebrated as the inception ‘Hridayapoorvam’, is aimed at making the general
day of Heart Care Foundation and during the very public ‘Heart care literate’, panchayath by
elegant official function each year, an eminent doctor,

48|CARING HEARTS|JULY-SEPTEMBER, 2021
32|CARING HEARTS|JANUARY - MARCH, 2022

panchayath. In a three phased There are many ways to actively associate
program, people of age group 30 to with Heart Care Foundation. Being a
60 will be given tests at the local labs member is the first step. Please get in
and the results will be fed in to a touch with any member or directly with
software program developed under the HCF office and they will guide you
the guidance of the HCF. The
program will analyze the cardiac risk
factor of each result and an
awareness session conducted by an
eminent cardiologist will make sure
that everyone understands their
cardiac health. Those with risks will
be advised to consult their local
physician and others will be given
general tips to keep up a healthy,
heart friendly life style. We have
selected Alangad Grama
Panchayath as the first locality for
the project and response from the
people as well as the government
agencies has been very heartening.
Hopefully, entire Kerala will soon be
Heart Care literate in a short while.

There are many ways to actively
associate with Heart Care
Foundation. Being a member is the
first step. Please get in touch with
any member or directly with the HCF
office and they will guide you.

We need your help. Let us help those
in need together.

Looking forward to your
association,

Dr. Jose Chacko Periappuram
Chairman, Heart Care Foundation

JULY-SEPTEMBER, 2021|CARING HEARTS|49
JANUARY - MARCH, 2022|CARING HEARTS|33

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Address: ............................................................................................................................................
Tel.No.:................................... Mobile No:............................. E-mail: .................................................

Category Of Membership: Individual Institutional Organization

Name of the institution /Organization :..................................................................................................

Address :............................................................................................................................................

.........................................................................................................................................................

Tel. No: .................................. Mobile No: ...................................... E-mail:.........................................

I Want to sponsor a poor heart patient and enclose herewith a sum of Rs. 25,000/part
thereof; and become a member of the Foundation.

I Want to be a subscriber of the quarterly health magazine ‘Caring Hearts' for 3 years
And become a member of the Foundation, by paying Rs. 1250/-

I Want to become a member of the Foundation (by donating any amount as affordable)

Please wherever applicable. cut here

Details Of payment favouring Heart Care Foundation, Kochi:
Amount (Rs) : .................................................... DD/Cheque No:........................................................
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Fill this coupon and post with your payment to:

Heart Care Foundation, 36/117 A 1, Second floor, Lisie Hospital Road, Kottecanal Junction, Kochi, Kerala - 682018
E-mail:[email protected], Web:www.heartcarefoundation.com
Tel: 0484-2406393, Mob: 9847006000

50|CARING HEARTS|JULY-SEPTEMBER, 2021
34|CARING HEARTS|JANUARY - MARCH, 2022

Governing Scan & Share
Council
Members Dear friends, from this issue onwards, Caring Hearts
will also be available as a digital magazine, easy to
Rev Fr.Austin Mulerikal read, just like a book. Check it out. More important-
Mr. O.T Alexander ly, scan the QR Code and share the magazine link
Mr. George Dominic with all you know, spreading the reach of Caring
Mr. Abdul Azeez Hearts and thereby Heart Care Foundation.
Mr. B.Binoay
Mr. Kochouseph Chittilapally
Mr. Thomas George Muthoot
Mr. George Thomas
Mr. Vinoo Devassy
Mr. Dinesh P. Thampi
Dr. Nisha Vikraman
Mr. Zachariah Poomkkudy
Mr. Raja Sethunath
Mr. Mathew Thayyil
Mr. T.V.Lukose
Dr. P.Sreekumar
Mr Prasad K. Panicker
Mr. S.Sivakumar
Mr. K.Venugopal
Dr. Praveen Pai

CARING HEARTS - January-March 2022. Regd. No: KERENG/2009/29265 - Price - Rs. 125.00