People with influenza stand the risk of a heart attack

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Vaccination can go a long way in preventing the onset of flu

New Delhi, 25 January 2018: Statistics indicate that people who get flu may be at a six-fold higher risk of heart attack in the week following infection. The risk of heart attack — or myocardial infarction — is particularly acute in older adults. These findings assume importance as an association between influenza and acute myocardial infarction reinforces the need for vaccination. While other respiratory viruses were also seen to raise the risk of heart attack, the incidence was not as high as the flu virus.

Influenza or ‘the flu’ is a highly contagious disease caused by infection from influenza type A or B (or rarely C) virus. These viruses infect the upper airways and lungs. Flu is not similar to a common cold and can be a serious illness. It is particularly of harm to the elderly and those with underlying medical conditions.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “During flu illness, our body is under a lot of stress and inflammation is up. Further, the oxygen levels and blood pressure can drop which can lead to an increased risk of blood clots in the vessels that serve the heart. All of these can cause heart attack. Vaccination is the best way to reduce the risk of getting flu. Being vaccinated gives you protection against flu by building immunity to the virus and preventing transmission of the virus to other people.”

The initial symptoms of flu include headaches, chills, and a cough. Other signs such as fever, loss of appetite, and muscle aches follow late. Apart from this, nausea, vomiting, and diarrhea are rare in adults but more common in children.

Adding further, Dr Aggarwal, who is also Group Editor of IJCP, said, “There are other complications of a flu such as bacterial pneumonia, ear infections, sinus infections, and worsening of chronic medical conditions, such as asthma, or diabetes. It is, therefore, important to not ignore symptoms of a flu. Chest pains and shortness of breath might indicate a lot more.”

The following tips can help prevent influenza.

  • Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
  • If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.
  • Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
  • Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
  • Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
  • Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

NHRC sends notice to a state-owned hospital over medical negligence

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ANI (Jan 22, 2018): This week on Monday, notices to the Chairman of Bharat Heavy Electricals Limited (BHEL) and the medical superintendent of BHEL hospital in Haridwar were sent by the National Human Rights Commission (NHRC) after a patient, who was allegedly alive, was declared dead.

The NHRC said in a statement, “By providing appropriate treatment in time, the life of the deceased could have been saved. The inhuman act done by the doctors has violated the right to life and health care of the deceased.” Observing this incident as the worst example of medical negligence by doctors of a state-owned hospital, the NHRC has called for a detailed report within six weeks along with action taken against the accused doctors and relief provided to the family of the deceased.

On January 12, a 44-year-old employee of BHEL was taken to the hospital after he complained of chest pain. He was declared dead by the doctors in the night and the body subsequently shifted to the mortuary. A postmortem was conducted on the body next day, which revealed that death had occurred about six hours before the postmortem i.e. around 8:00 am, showing a gap of more than eight hours after the patient had been declared dead. A complaint against doctors alleging medical negligence has been filed by the family following which an inquiry has been ordered into the incident.

One possible scenario that may explain this situation is that the patient was in hypothermia, which went unrecognized, and the patient died later on.

Hypothermia in adults is defined as core temperature below 35°C. Hypothermia can be mild (core temperature 32 to 35°C), moderate (core temperature 28 to 32°C) and severe (core temperature below 28ºC).

The clinical staging scheme described by the International Commission for Mountain Emergency Medicine describes Stage 1 hypothermia as mild hypothermia with normal mental status with shivering, moderate or stage 2 hypothermia as impaired mental status, shivering may be or may not be present. In stage 3 hypothermia (severe; core temperature 24 to 28°C), the person is unconscious. Stage 4 hypothermia (severe; core temperature 13.7 to 24°C) is apparent death but resuscitation may be possible. While,stage 5 hypothermia is death due to irreversible hypothermia and it is not possible to resuscitate the person.

Cooling decreases tissue metabolism and inhibits neural activity. In mild hypothermia, shivering due to skin cooling generates heat and increases metabolism, ventilation, and cardiac output. As the body temperature falls, the cold slows down metabolism. Once the core temperature reaches 32°C, metabolism, ventilation, and cardiac output begin to decline and shivering becomes less effective in retaining heat until it finally stops as core body temperature continues to decline. For each 1°C fall in body temperature, the body metabolism slows by around 6%; at 28°C, the basal metabolic rate is about half of normal.

Neurologic function begins declining even above a core temperature of 35°C. Patients often lose consciousness; vital signs may be absent. Presence of muscle rigidity without shivering can be mistaken for rigor mortis. The absence of shivering and presence of stupor, skin flushing, muscle rigidity, hypoventilation, and circulatory failure means very cold patients often appear dead rather than hypothermic. But in this stage of severe hypothermia (core temperature <28°C or 82°F), a suspended metabolism may protect against hypoxia.

Stage 4 hypothermia must be excluded, which is the stage where it is still possible to revive the patient. Failure to recognize the condition of hypothermia may be the reason why severely hypothermic patients are sometimes pronounced dead. It may be possible to successfully revive a person if recognized in time. No patient therefore should be declared dead without measuring rectal temperature.

The cadaveric signs are algor mortis (cooling of the body after death), rigor mortis (rigidity, which begins within 2 hours of death and lasts for about 24 hours), liver mortis (lividity or pooling of blood in the dependent parts of the body; it is most evident after 2 hours of death and becomes fixed within 4-6 hours), cadaveric spasm and putrefaction. These postmortem changes begin soon after death and progress along a timeline but factors like ambient temperature may affect their development.

So, could this be a case of erroneous or misinterpretation of postmortem findings?

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA