No symptoms. Normal hormone levels. And then, one scan changed my life.

 

Dr. Natasha Das,

Consultant, Medical Communications

A papillary thyroid carcinoma patient

On the 16^th of July, I mark one year since a diagnosis that shook my near and dear ones. Until then, I was a doctor and a medical communications professional leading a normal ‘healthy’ life and conducting outreach programs and training people how to do a self-examination of the breast and the oral cavity for early detection of cancer.  

I have always believed in the power of early detection. Now, I have lived it.

The clue I missed – and my friends did not

A year ago, a friend, who is also a doctor, noticed something I hadn’t – a slight swelling on my neck. I had no symptoms. No pain. No voice changes. No trouble swallowing. And like many patients, I could have dismissed the swelling as harmless, especially in the absence of symptoms. But as a doctor, I knew better.

It turned out later, my thyroid hormone levels also were within normal limits. All that I had was just a visible lump that I had not known of till then.  

A few weeks later, another friend nudged me to get a scan to check if it was only a cyst (a fluid filled sac) or a solid tumor. 

The clinical examination

Next, I got myself clinically examined by a physician friend. She examined the swelling and said it felt like a cyst and there may not be much to worry. She insisted that in spite of the normal hormone levels, a swelling is an abnormality. She advised me to get an ultrasound scan followed by a fine-needle aspiration cytology (FNAC) to be sure it was a benign cyst.

The ultrasound that revealed a silent story in the other lobe

I went in expecting the scan to confirm a benign nodule in the area of the swelling. Instead, the ultrasonologist noticed something entirely different.

He didn’t just scan the obvious lump. He thoroughly examined the entire neck. His attention to detail changed the course of my care.

Yes, there was a cyst in the right lobe of the thyroid that did seem to be benign. But the ultrasonologist found foci of microcalcification in the left lobe of the thyroid. Microcalcifications are detected by the ultrasound as small, bright spots – a red flag for thyroid cancer. The ultrasonologist insisted that I get an FNAC from the left side rather than the right.

I cannot emphasize this enough. It was his skill and thorough examination that brought the true picture to light.

A quick and conclusive FNAC report

While the tiny bright spots (less than a mm in diameter) detected by ultrasound were a strong indication of thyroid cancer, they could also have been due to benign conditions such as Hashimoto’s thyroiditis. Because of its association with cancer, since microcalcifications were identified, a thorough evaluation was crucial.

Although I was advised to get an FNAC done with a sample from the left lobe, there was no lump on the left that could be seen or felt. The pathologist therefore, went in for an ultrasound-guided FNAC. The ultrasound was used to locate the position of the microcalcifications. A fine needle was used to withdraw cells from there. These cells were then examined under the microscope to determine if there were any cancerous cells.

It was the FNAC that confirmed the diagnosis of papillary thyroid cancer.

Ultrasound to detect the spread of the cancer

Once the diagnosis was confirmed, a surgery was planned. But before that, the cancer surgeon needed to know about the spread of the cancer.

He advised another ultrasound of the neck. This time, with the cancer already diagnosed, the ultrasound was used to assess the lymph nodes in the neck for any signs of metastasis or spread of cancer.

When the cells in the lymph nodes die, the lymph nodes become what doctors call ‘necrotic’. Necrotic lymph nodes often appear darker on the ultrasound monitor.

This second ultrasound of my neck revealed several necrotic lymph nodes indicating spread of the cancer.

CE CT scan to rule out the rare possibility of abdominal or pelvic mass

In rare cases, follicular or papillary thyroid cancers have presented as pelvic masses or as asymptomatic pelvic bone metastases.

I also underwent a contrast-enhanced computed tomography (CE CT) scan of the abdomen and pelvis to rule out any abnormality in these areas.

Surgery and biopsy that helped determine the staging of the cancer

Since one lobe of my thyroid had a large visible cystic swelling and the other lobe had cancer, the surgeon decided to remove the thyroid gland completely.

As ultrasound had revealed necrotic lymph nodes in the neck, the surgeon decided to clean the neck and remove the nearby lymph nodes.

The surgeon also decided to remove one of the four parathyroid glands as it was too close to the affected area and might harbor cancer cells.

While necrosis of lymph nodes on an ultrasound often points to spread of cancer, it is important to consider other possibilities such as tuberculosis, fungal infections and other chronic inflammatory disease.

The removed thyroid gland, parathyroid and neck lymph nodes were sent for biopsy. There were multiple cancerous nodules in the thyroid and the largest one had a diameter of over 2 cm. The cancer was confined to the thyroid. It had spread to four of the neck lymph nodes but there was no distant spread. The cancer was therefore, staged at T2N1M0. Since I was less than 55 y old at diagnosis, this was considered as stage I papillary thyroid cancer.

Adjuvant therapy after the surgery

After the surgery, I underwent adjuvant nuclear therapy in the form of radioactive iodine (RAI) therapy.

The RAI therapy ensured that any remnant thyroid tissue or microscopic disease was treated. It also completed the active phase of my treatment.

A follow-up scan after the RAI therapy ensured that all thyroid cells in my body had been killed.

A pill each morning – that’s all it takes to keep me going

Once the RAI therapy was done, it meant all my thyroid cells were killed – even that microscopic amount that have been left behind after the surgery.

I need thyroid hormones for overall functioning of my body. As my body no longer produces these hormones, I have been put on thyroid hormone replacement therapy.

This means every morning, I get up and take a pill that gives me enough thyroid hormones to allow my body to work to its optimum ability.

A final word – the power of looking closer and paying attention

When I reflect today, 1 year after the diagnosis, on what saved me – I believe it wasn’t just a machine and a test. It was the people behind them who looked closer and paid attention.

A friend who saw what I didn’t.  The ultrasonologist who paid attention to the left side too when the swelling was only on the right side. The pathologist who confirmed the diagnosis. The ultrasonologist who found the necrosed lymph nodes. The surgeon who carefully removed my thyroid gland without any damage to the nerve to my voice box, who removed the neck lymph nodes carefully and sent it for biopsy. The pathologists who did the biopsy and confirmed that the spread was limited only to a few nearby lymph nodes.

My case is a reminder that medicine is as much about vigilance and intuition as it is about technology.

So, if you—or someone you care about—has a neck swelling, don’t ignore it. Even if it is painless. Even if your lab tests are normal. Even if you feel fine. Ask your doctor about an ultrasound. Make sure the scan is detailed and done by someone experienced in thyroid imaging. And follow through if something looks suspicious.

Because early detection doesn’t just improve outcomes. Sometimes, as in my case, it changes everything.

 

P.S.

One year after the diagnosis, I am doing well. 

My last whole-body scan had shown no remnant thyroid cancer cells anywhere in my body.

As a panel moderator at the recently concluded DIA Medical Writing Conference 2025

Grateful to these people in my cancer journey

Dr. Sanjusmita Tripathy, Dr. Preeti Srivastava, Dr. Sharmistha Sarangi, Dr. Biswajit Mishra, Dr. Sandeep Mohanty, Dr. Ranjan Mohanty, Dr. Pradyumna Kumar Sahoo, Dr. Manas Ranjan Baisakh, Dr. Rabi Narayan Mallick, Dr. Manoranjan Mohapatra, Dr. Saroj Kumar Sahu, Dr. Tushar Mohapatra, Dr. Saurendra Das, Ar. Santrupthy Das, Mr. Animesh Das, Dr. Bibhupada Mohanty, Mrs. Yashodhara Das, Mrs. Alaka Das, Mr. Nilolohit Mohanty, Mrs. Mandakini Mohanty, Ms. Swetapadma Acharya, Dr. Purvish Parikh, Dr. Pratap K. Das, Dr. Ghanashyam Biswas, Dr. Soumya Surath Panda, Mr. Ravi Shankar Sharma, Mr. Debakanta Kar and many others.

Also, Zulie bhai (Late Dr. ZH Khan) who always encouraged me to spread awareness for early detection of cancer.

When you have cancer, you do not travel alone. And that’s what makes all the difference. I share my story now so others will listen sooner—to their bodies, to their instincts, and to those who care enough to speak up. Because sometimes, one scan and one set of careful eyes is all it takes to change the ending.

Anxiety in Teenagers: Signs Parents Shouldn't Ignore

- Medical Communication Intern, Summer 2025 Cohort

Teenage years are a rollercoaster — emotionally, socially, and physically. Today’s teens face an overwhelming mix of academic pressure, social media, and uncertainty about the future. It’s no surprise that anxiety in teenagers is on the rise.

WHO estimates that anxiety disorders affect about one in ten adolescents globally; yet, many go unnoticed or are brushed off as "just teen drama." As a parent or caregiver, knowing what to look for — and when to act — can make a world of difference.

What is teen anxiety, really?

Anxiety is our body’s natural response to stress or danger — the “fight or flight” instinct. But when that response gets triggered too often, too easily, or without a clear reason, it can become a problem.

According to the United States Centers for Disease Control and Prevention (CDC), anxiety disorders in teens involve intense, excessive fear that doesn't go away on their own — and they interfere with school and personal relations.

Common types of anxiety in teens include:

I. Generalized Anxiety Disorder – constant worry about many aspects of life

II. Social Anxiety Disorder – fear of being judged or embarrassed in public

III. Panic Disorder – sudden, intense bouts of fear (panic attacks)

IV. Phobias – irrational fears of specific things (e.g., needles, elevators)

V. Separation Anxiety – fear of being apart from loved ones

Warning Signs Parents Shouldn’t Miss:

1. Constant worrying or overthinking

Your teen might seem stuck in their head — worrying about school, relationships, or the future — and it never seems to stop. It might seem out of proportion to what’s going on.

 2. Avoiding school or social situations

A teen with anxiety may start dodging school, refusing to go to events, or even avoiding friends. This is especially true with social anxiety or panic disorder.

 3. Physical Complaints with No Clear Cause

Stomach aches, headaches, chest pain, or even dizziness can all be signs of anxiety. These aren’t made up — anxiety can physically affect the body.

 4. Trouble Sleeping

Struggling to fall asleep, waking up frequently, or feeling tired all the time despite a full night’s sleep can be signs that something’s bothering your teen mentally.

 5. Irritability and Mood Swings

An anxious teen might snap more easily or seem more agitated. While mood changes are part of being a teen, persistent irritability can be a clue to deeper struggles.

 6. Perfectionism or Fear of Failing 

Some teens push themselves relentlessly, fearing any mistake. While ambition is healthy, constant self-criticism or burnout may signal anxiety.

 7. Changes in Eating Habits 

Eating much more or much less than usual, or unexplained weight changes, can also be linked to anxiety or emotional stress. 

Why Parents Should Take These Signs Seriously 

Ignoring these signs or dismissing them as “just a phase” can delay necessary intervention.

Early identification and appropriate treatment can significantly improve outcomes. Left untreated, anxiety disorders can persist into adulthood and increase the risk of substance abuse, self-harm, or suicide. 

When to Seek Professional Help 

Consult a mental health professional when: 

●      Symptoms persist for more than a few weeks 

●      Anxiety starts to interfere with school or personal life 

●      Your teen expresses feelings of hopelessness or talks about self-harm 

What Help Looks Like 

1. Therapy 

Cognitive Behavioural Therapy (CBT) helps teens recognize and manage anxious thoughts and behaviours. It’s research-backed and widely considered the gold standard in treatment.

2. Medication 

Selective serotonin reuptake inhibitors (SSRIs) or anti-anxiety medications may be prescribed for moderate to severe cases but should always be managed by a licensed psychiatrist. 

3. Lifestyle Changes 

Regular sleep, physical activity, healthy meals, reducing screen time and practicing breathing exercises can help in the long run.

Guide Your Teen

You don’t need to have all the answers. What your teen needs most is to feel safe, heard, and not judged. 

• Ask open-ended questions. 

• Avoid dismissing their feelings with “just relax” or “you’ll be fine.” 

• Keep communication consistent, even if they push back. 

“Parents can be their teen’s first line of defense.” Knowing when to lean in — and when to get help — can change a young person’s life. 

Final Thought 

Teen anxiety isn’t just a phase. It's a real and growing concern. As a parent, your job isn’t to “fix” everything — but to listen, observe, and act when needed. The earlier anxiety is recognized and addressed, the better the chances for a happy, healthy future.

Resources

[WHO – Adolescent Mental Health](https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health) 

 [CDC – Anxiety and Depression in Children](https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html) 

[Mayo Clinic – Teen Anxiety](https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961)

[Cleveland Clinic – Anxiety in Teens](https://my.clevelandclinic.org/health/diseases/9632-anxiety-disorders) 

[NHS – Anxiety in Children and Teens](https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/anxiety-in-children/)

The rising importance of mental health days at work

 - Medical Communication Intern, Summer2025 Cohort

With work demands increasing every day, it’s easy to overlook the importance of mental health. Since a long time, organizations have acknowledged that sick days were necessary for employees who were physically ill. However, they are only recently starting to realize that mental health days are just as needed.

 What is a mental health day?

A mental health day is a day when you use your time outside of work to focus on relaxing and caring for your mental wellness. It allows you to take a break from your routine stress and relax mentally and emotionally when you’re feeling too much stress or anxiety or are close to burnout.

If you slow down when you have the flu, it helps you bounce back faster and may stop you from infecting people. Similarly, taking a day out for your mind helps stop emotional stress in the long run.

Why mental health days are becoming more important

Several things are encouraging more companies to recognize mental health days.

In late 2019, the World Health Organization recognized _‘burnout’_ as the official name for ongoing stress at work.

Young people are recognizing and sharing their mental health needs more easily and organizations are responding.

Improved mental health allows workers to think creatively, choose wise goals and produce more effectively.

Every year, companies lose billions because of workers who have mental distress and perform less effectively on their jobs.

It can be hard to relax, but watching out for these signs is helpful.

• Burnout, weariness or tiredness
• Having trouble concentrating or deciding
• Worrying a lot, having a bad mood or feeling like no emotions exist
• Sleep problems or eating less
• Not wanting to do the things you usually pick as activities you find fun doing.

Ways employers can assist employees on mental health days

To make mental health days respected, it must start with the leaders themselves.

Organizations can help by providing the following:

• Normalize conversation about stress and burnout throughout the organization. 
• Modify current leave guidelines, if needed. Sick leaves should be used to address both physical and mental health problems. 
• Train supervisors. Supervisors should be able to recognize signs of stress presents and respond to workers with empathy.
• Encourage your staff to switch off after work and plan for time off.

When the organization helps their employees in this manner, it will also boost its own output and growth.

Ensure you have a happy and relaxing mental health day

• Disconnect from your job by turning off email and work chatting.
• Before going to bed, spend a few minutes in calm nature, read something heartening or meditate.
• Connect with someone you trust, whether it’s a friend or a therapist.

There’s no reason to feel guilty when you need a break from your feelings.

While mental health days won’t solve everything, they can be a real help if you use them right. 

Caring for your mental health is something you cannot ignore; it’s crucial. Taking a mental health day prevents exhaustion, energizes you and supports your productivity over the long run. Most importantly, they allow us to remain humane in a tough environment. Just like paid sick days, mental health days will soon be considered a requirement for companies.

References

Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

World Health Organization (WHO): https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/mental-health-in-the-workplace

Centers for Disease Control and Prevention (CDC): https://blogs.cdc.gov/niosh-science-blog/2024/04/15/workplace-mental-health-resources/

 

Parkinson's disease - What it is and how you can look after someone with Parkinson's disease

- Guest authored by B. Swain

Is buttoning a shirt or picking up and holding a cup of coffee often a challenge for you?

This is the reality for millions of people with Parkinson's disease, a neurological condition that impacts everything in your life. If you or a loved one has been diagnosed with Parkinson's disease, it is understandable to feel overwhelmed. But with the proper information and attention, individuals with Parkinson's disease can live a full and independent life for many years.

What is Parkinson's Disease?

Parkinson's disease is a nervous system disorder that most directly impacts movement. It is caused by the slow deterioration or death of brain cells that produce dopamine, a chemical involved in carrying messages that govern movement and coordination. Parkinson's disease is the second most prevalent neurodegenerative disorder and currently affects over 8 million people globally. Although the exact cause of Parkinson's disease still remains unknown, both genetics and environmental causes are believed to be involved.

Symptoms of Parkinson's Disease

The symptoms of Parkinson's disease typically appear gradually over a period of time and may differ from individual to individual. These typically can be divided into motor and non-motor symptoms.

Motor Symptoms:

• Tremors – Involuntary trembling, typically beginning in the hands or fingers.
• Bradykinesia (slowness of movement) – Reduction in spontaneous and voluntary movements.
• Muscle rigidity– Stiffness in the muscles, which causes difficulty in movement and pain.
• Postural instability– Balance and coordination impairments, increasing the risk of falls.
• Facial masking– Decreased facial expressions because of facial muscle stiffness.

Non-motor Symptoms:

• Cognitive changes– Memory impairment and difficulty in concentration.
• Depression and anxiety– Mood disorders 
• Sleep disturbances – Insomnia, restless legs syndrome, excessive daytime sleepiness
• Digestive problems – Difficulty in swallowing and constipation.
• Loss of smell – A less discussed, yet prevalent, early symptom of Parkinson's disease.

Caring for a Person with Parkinson's Disease

Caring for a loved one with Parkinson's disease demands patience, empathy, and an active attitude. Here are some practical tips on how to offer support:

1. Support Regular Exercise

Exercise is the most effective method of slowing down the progress of Parkinson's disease. Walking, swimming, and martial arts such as tai chi improve mobility, balance, and flexibility. Physical therapy can also be helpful in allowing movement and decreasing stiffness.

2. Offer a Balanced Diet

A healthy diet may assist in controlling symptoms and enhancing well-being. Foods high in antioxidants (e.g., berries, greens, and nuts) may protect the brain. Eating foods high in fiber and drinking plenty of water can aid digestive problems such as constipation.

3. Promote Adherence to Medication

Parkinson's medication, such as levodopa, replenishes the levels of dopamine in the body and controls the symptoms. Make sure your loved one is reminded to take medication at the proper time because omitting a single dose can easily affect their mobility and overall condition.

4. Ensure the Home is Safe and Accessible

Individuals suffering from Parkinson's disease are more susceptible to falls.Make your home a safe environment for such people. 

• Remove any loose rugs that may they are likely to trip over.
• Fix grab bars in the bathroom.
• Provide good lighting in the entire house.
• Use non-slip shoes and mats.

5. Provide Emotional Support

Managing Parkinson's disease is an emotional rollercoaster for the caregiver as well as the patient. Maintain open communication, hear them out, and make them understand they are not isolated. Support groups, counselling, and meditation can aid in dealing with stress and depression.

6. Assist in Daily Activities

As Parkinson's disease advances, everyday activities like dressing, eating, and bathing can be challenging. Assisting while promoting independence can preserve their dignity. Adaptive equipment, such as utensils with larger grips or clothing without buttons, can simplify daily tasks.

7. Watch for Cognitive Changes

Some people with Parkinson's disease may have cognitive decline as they age. Monitor any changes in memory, thinking, or behavior and talk to a healthcare provider when in doubt. Cognitive therapy and mental exercises, including puzzles and reading, will maintain brain function.

8. Promote Social Interaction

Loneliness and isolation can exacerbate the symptoms. Encourage them to engage in social activities, hobbies, or community participation. Talking and maintaining relationships with friends and family can enhance their emotional well-being.

Caring for Yourself as a Caregiver

• Caring for someone with Parkinson’s can be physically and emotionally exhausting. It’s important to take care of yourself as well. 
• Take breaks when needed and ask for help from other family members or professional caregivers.
• Join a caregiver support group to connect with others in similar situations.
• Prioritize self-care, including exercise, healthy eating, and relaxation.
• Most importantly, take care of your mental health. Ask for help if needed. Don’t let your energy be drained completely; take breaks.

Parkinson's disease is a difficult condition for the patient as well as the caregiver. Take care of both. With proper care and support, people can lead meaningful and productive lives. As a caregiver, your contribution is priceless in making those with Parkinson’s disease feel comfortable, safe, and emotionally sound.

By being well-informed, promoting independence, and creating a positive atmosphere, you can make a big difference in the life of a person with Parkinson's disease.

If you or a loved one is touched by Parkinson's disease, seek the advice of healthcare providers and support groups to sail through the journey together.

DCIS - What is it? Is that really "not cancer"?

In a recently released video. actor Mahima Chaudhary narrates that during an annual screening, she was detected with 'DCIS'. 

What is DCIS? Is it cancer? Is it not?

I thought I owe this explanation to my readers. So, here I go. Read on to find out. 

Why did she need an annual screening? 

Why did  Mahima go for that annual screening? Was there a real need when she showed no symptoms? 

Screening means getting tests to detect cancer as early as possible - even before you have any symptom. 

Read more about cancer screening tests here and talk to your doctor to know whether you should be annually screened for breast cancer. 

What is DCIS?

DCIS is the short form for 'ductal carcinoma in situ'. 

It is also called intraductal carcinoma. 

Is DCIS cancer? 

Yes, DCIS is cancer. 

It is a very early stage of breast cancer. 

Let's understand the term 'ductal carcinoma in situ'. 

Carcinoma, as you may recall, is just a more technical terminology for cancer. 

Ductal carcinoma refers to the detection of cancer cells inside the milk ducts of the breast. 

'in situ' means it is situated 'in its original place'. 

'in-situ carcinoma' is a term used for cancer that is non-invasive or 'pre-invasive' which means it has not yet reached a stage when it has spread out through the walls of the milk duct. 

This is very early stage of breast cancer. The cells inside the milk duct have become abnormal or changed to cancer cells but they have not yet spread through the walls of the milk duct to the nearby breast tissue. 

Should I be bothered about DCIS?

DCIS is usually found during a screening mammography. It is detected as small irregulat clusters of calcification on the mammogram. 

Typically, it does not have any signs or symptoms. It can sometimes cause signs such as

 

*  Breast lump

*  Bloody discharge from the nipple

DCIS still has not spread outside the duct. As it has not spread into the adjoining breast tissue, it cannot metastasize (or spread to distant parts of the body). 

DCIS can sometimes become an invasive cancer. When this happens, the cancer can spread to adjoining breast tissue as well as to cause distant metastasis. 

Currently, there are no sure-shot ways to know which DCIS cases will turn into invasive cancer and which will not. 

How is DCIS treated?

A woman with DCIS can choose to get only the affected area removed (lumpectomy or breast-conserving surgery) or get all the breast tissues removed (simple mastectomy) as a preventive measure. 

Usually, after a breast-conserving surgery, radiation is given. Radiation therapy kills the cells in the margin of the operated area to prevent growth of abnormal cells there. 

If the DCIS is hormone-receptor positive, the doctor may suggest medicines that can arrest the growth of cancer cells.  

The bottom line

DCIS is cancer which is in a very early stage and has not spread to the adjoining breast tissues. 

A close watch and an early and effective treatment can cure DCIS. Thus, DCIS is a curable stage of breast cancer. It is, therefore, also called stage 0 breast cancer. 

Rushing a person having a heart attack can endanger his life further.

The videos are going viral. By now, you have probably watched the last video of the popular singer KK. When he complained of chest discomfort, he was rushed out of the concert where he was performing and immediately taken to Calcutta Medical Research Institute. He was declared "dead on arrival". 

This may sound shocking but the organizers and managers might have actually endangered KK life further by making him run to the car. 

Take a look at the video once again.

KK was visibly in discomfort. He was showing typical signs of a a heart attack. 

During a heart attack, a person's heart rate may be increased or may remain the same. An increased heart rate is not a specific sign of a heart attack. 

Do not panic

When someone near you has signs or symptoms suggestive of a heart attack, the first thing for you is to stay calm while taking measures to help the person. 

By creating a panic situation around KK and making him run, what people did was this. They put his body in a further stressful condition. This is expected to have increased his heart rate. 

When the heart rate increases, it means the heart is beating faster. It is working harder to pump the blood. As a result, the heart's own need for oxygen increases. 

Damage to the heart

When a heart attack occurs, the heart muscles are damaged due to lack of oxygen. The amount and severity of the damage depends on several factors. 

According to the American Heart Association, it depends on: 

• Size of the area supplied by the blocked artery
• Oxygen need of the heart muscles
• Time between the heart attack and the start of treatment

The damaged area of the heart heals over several weeks by forming a scar tissue. Heart is a very powerful muscle. Even if some part of the heart may be scarred after a heart attack, the rest of the heart continues to pump blood into different parts of the body. 

The damage however, makes the heart weak and it is unable to pump blood as efficiently as before. 

Heart rate can sometimes predict death rate. 

According to a study published in the European Heart Journal, when the heart rate at admission is high (more than 80 beats per minute), it is significantly associated with in-hospital death. 

Exercise and stress are both known to increase the heart rate. Stress during a heart attack also increases the blood pressure and the heart's need for more oxygen. 

What to do?

If you think someone is having a heart attack, here are some things you can do. 

** Have the person sit down, rest and try to keep calm. Ensure they are comfortable, sitting on the floor and leaning against a chair or a wall. Ask them to keep their knees folded. Place pillows below the knees. Sitting eases the strain on the heart. It will also ensure they do not hurt themselves if they collapse.

**Loosen any tight clothing such as a belt or a necktie. This will make it easier for the person to breathe. 

**People who have angina (a squeezing chest pain) are at an increased risk of heart attack. They are prescribed angina medications such as nitroglycerin. Ask if the person takes any chest pain medicines, such as nitoglycerin for a known heart condition. Help them take the medicine. 

**If the pain does not go away promptly with rest or within 3 minutes of taking the chest pain medicine, it is safer to pressume that it is a heart attack. Call emergency. That's 911 if you are in the USA and 102 for ambulance service in India. 

**A tablet of nitroglycerine will usually relieve the pain within 1 to 5 minutes. If it does not, while you are waiting for emergency help to arrive, give another nitroglycerine tablet after 5 minutes. 

**If the person is not on an angina medication or the medicine is not available, ask them if they are allergic to aspirin or have any medical condition where aspirin must not be given. Once you know it is okay to give them aspirin, you can give them 325 mg of aspirin tablet. Ask them to chew it slowly. Time is critical during a heart attack. Instead of swallowing the whole tablet, if they chew it slowly and then swallow, it will be absorbed faster and will be more effective. Aspirin is a blood thinner. It helps to remove the blockage in the artery. Aspirin takes about 15 minutes to start its effect. So, remember to call an ambulance. 

**If the person becomes unconscious or unresponsive, start CPR without delay. 

What not to do?

Do not give aspirin without checking. Give an aspirin only if you know the person is not allergic to aspirin or does not have a medical condition where aspirin is contraindicated or can cause serious side effects. 

Do not leave the person alone except to call for help, if needed. 

Do not allow the person to convince you not to call for emergency help. 

Do not wait to see if symptoms go away. A heart attack is an emergency. 

Do not panic though. Only if you are calm can you keep the person calm and rested till help arrives. 

A sudden cardiac arrest is not the same as a heart attack

Popular Bollywood singer KK was merely 53 when he suddenly died after performing at a concert at Kolkata this week. As I flipped through news posts today, I noticed that some news headlines say he died of a heart attack while other headlines say the cause of the death was a sudden cardiac arrest. A sudden cardiac arrest is not the same as a heart attack. 

For the benefit of my readers, let me try and make it clear why the two terms cannot be used interchangeably. Also, we need to remind ourselves that just two steps taken as an emergency measure could have increased the chances of KK's survival. 

Singer KK was merely 53 years old when he suddenly died after a concert on 31 May 2022. Could prompt emergency measures have prevented the casualty? 

The heart is a muscular pump that pushes blood into different parts of the body through a network of blood vessels. The heart muscles get their nutrition and oxygen supply through blood vessels called coronary arteries. 

What causes the heart to beat? The heart beats due to contraction and relaxation of its muscles.  Different parts of the heart contract and relax when an electrical signal passes through them like a wave. This wave-like signal is generated in the right upper chamber of the heart and then passes to its other areas. 

Simply put, a heart attack is when the blood flow to a part of the heart is blocked as one or more of the coronary arteries or their branches is blocked. 

In contrast, a sudden cardiac arrest (SCA) is when the heart does not beat normally and suddenly stops beating because the wave-like electrical signal that generates heart beats is disrupted. 

Heart attack represents a problem in the circulation of oxygen-rich blood to parts of the heart whereas an SCA represents a problem with the electrical signalling that makes the heart beat. 

Heart attack

When an artery in the heart is blocked due to cholesterol or fat deposits or due to a blood clot, oxygen-rich blood does not reach the specific area of the heart that the artery supplies. 

If the blocked artery is not reopened quickly or a bypass route is not created, the cells in the part of the heart which is normally supplied by that artery start to die due to lack of oxygen. If the person goes without treatment for a longer duration, more areas of the heart get less oxygen and nutrition and more cells die. 

'Myocardium' means the muscle tissues of the heart. "Infarction" means the death of tissue due to loss of blood supply. Now you know why a heart attack is also called a 'myocardial infarction' or simply 'MI'!

Symptoms of a heart attack or MI can be immediate and intense but more often, the symptoms start slowly and persist for hours, days, or weeks before the intense chest pain we often associate with a heart attack. 

Common symptoms of a heart attack include chest discomfort, discomfort in other parts of the upper body, shortness of breath, cold sweat, nausea, and breathlessness. Men and women can have different symptoms suggestive of a heart attack. 

If you notice any of these warning signs, and even if you are not sure this is a heart attack, please call emergency. Every second matters. Consult a cardiologist even if the symptoms do not persist for long. 

The cardiologist will run a few tests to confirm if it was a heart attack and then, treat the blockage to prevent future heart attacks.

Sudden Cardiac Arrest

An SCA occurs suddenly without much warning. It occurs when either the heart stops beating completely or when the heart is not beating sufficiently to pump blood to different parts of the body. 

Like I explained before, heart beats are a result of the contraction and relaxation of the heart muscles.

An electrical impulse generated inside the right upper chamber of the heart travels to other parts of the heart. As this impulse passes through different parts of the heart, it causes a wave of contractions and relaxations. As a result, the heart beats and pumps the blood. 

When there is a disruption in these electrical impulses, the heart stops beating or beats insufficiently. The heart is unable to push blood to the brain, lungs, and other parts. When the brain is deprived of oxygen, within seconds, the person loses consciousness and you may not be able to feel their pulse. Death can occur within minutes if the person does not receive immediate care. 

The Link

Though an SCA is not a heart attack, the two are linked. 

SCA may occur after a heart attack or during the recovery from a heart attack. 

Most heart attacks do not lead to SCA but when an SCA occurs, a heart attack is a common cause. An SCA may occur due to a heart attack or due to other causes as well. 

Other causes of sudden cardiac arrest

A sudden cardiac arrest may also ocur due to inherited abnormalities in the signal pathway that causes the heart to beat.

It can also occur due to abnormalities or dysfunction of the heart muscles. The medical term for this is 'cardiomyopathy'. Alcohol consumption, obesity, fibrotic diseases and inflammations can increase the risk of cardiomyopathies. 

Heart failure, valve disorders and some congenital abnormalities can also increase the risk of SCA.

How can you help?

When you see some one showing symptoms suggestive of a heart attack or an SCA, do not waste any time. 

Call emergency immediately. 

That's 911 if you are in USA . 

If you are in India, call 102 for ambulance service. 

A person having a heart attack may still be breathing and talking. They do not need a cardiopulmonary resuscitation (CPR). But they still need to be sent to the hospital immediately. So, call emergency or ambulance service. 

In contrast, if the person is not breathing and has become unconscious, it is probably an SCA. Call emergency and start hands-only CPR immediately. Even if you are alone with the person, you can start hands-only CPR. 

1. Call emergency. 

2. Start CPR immediately. 

In case of a heart attack, follow step 1. In case of an SCA, follow steps 1 and 2  without delay. These two steps can increase the chances of survival. Cardiac arrest is reversible if CPR is done within minutes. 

Continue the CPR till professional help arrives. With swift action, you can help revive a person from cardiac arrest.  

CPR uses chest compression to mimic heart beats and forces blood into different body parts. It keeps enough oxygen in the lungs and gets it to the brain till normal heart rhythm is restored by professional emergency service providers. 

When the professional emergency service providers arrive, they may use an electric defibrillator to send an electrical impulse to the heart. This electric shock provides an external electrical signalling that can get the heart to beat on its own once again. 

It's an emergency!

You do not need to be professionally trained to do a CPR. 

If you see someone falling down unconscious, without wasting time, just bend down and try to wake them up. Check if they are breathing. If they do not seem to be breathing and you do not feel their pulse. start CPR immediately. 

While kneeling beside them, use both your hands to press on the middle of their chest. Push hard at a rate of about 100-120 times a minute. Keep doing that till help arrives. You can continue CPR for about 10 minutes without stopping in between. 

Here are a few helpful videos that tell you how to do a hands-only CPR while waiting for an ambulance to arrive. 

• A 1-minute video by the American Heart Association that gives you just the basics about hands-only CPR
• A nearly 2.5-minute video  of cardiologist Late Dr. KK Aggarwal showing you the details and some alternative ways to do a CPR in case you cannot use both your hands. 

If you found this post helpful, do leave me a comment. 

If you have seen a person revive from an SCA due to prompt action, tell us about it.