In this presentation, Dr Vivek Baliga discusses chronic heart failure management in the setting of diabetes.
This is a medical presentation meant for medical professionals and not patients (feel free to go through it though!)
Congenital Birth Defects – Dr Vivek Baliga Article
The development of the human body is a work of wonder. Starting out from tiny cell, it divides rapidly over a period of 9 months, finally emerging out of the womb as a bundle of joy.
The birth of a child is amazing, and the first look that we as parents have of the fetus in the womb on the ultrasound scan is nothing but memorable.
The primary purpose of these scans is to pick up any defects early on during development, so that appropriate action can be taken if needed.
While the process of development of a foetus in the womb is probably the most organised process in the world, it is not uncommon for things to go wrong sometimes.
Defects that occur in the structure of the tissues during foetal development are called congenital defects.
Studies have shown that in India, 70 out of 1000 live births have birth defects. There are many kinds of congenital defects, some of which we have discussed below.
Risk Factors
What are the risk factors that can lead to an increased chance of the fetus developing congenital defects?
The common ones include –
- Increased maternal age – Women who have babies over the age of 35 years are at increased risk
- Poor planning of pregnancies
- Improper antenatal care – This refers to care taken prior to and just after conception.
- Pre-existing medical conditions in the mother such as diabetes, high blood pressure and epilepsy
- Consanguineous marriages – This refers to marriages between close relatives. This is more common in south India.
- Poor maternal nutrition – This includes consumption of alcohol and smoking during pregnancy
- Low socioeconomic conditions
Common Congenital Disorders
Heart defects
These are probably the most worrying to all parents.
A congenital heart defect is often regarded as a simple hole in the heart, but it is a lot more than that.
Sometimes, the blood vessels that emerge from the heart may develop in a ‘reverse direction’, resulting in oxygen poor blood getting circulated through the body.
Babies with these defects may have breathing difficulties, rapid heart beating, problems with feeding, bluish skin and even swelling in the legs.
These defects usually need some form of surgical correction. Some may need pacemakers.
Modern technology now permits detection of heart defects in the very early stages of foetal development. This way, action can be taken sooner rather than later.
Down syndrome
This is a well recognised birth defect amongst the general public.
It is seen in 1 in 800 births, and children typically have features such as small, slanted eyes, a small mouth, folded ears, large tongue, flattened nose and small hands and fingers.
Around 50% of children with this condition have hearing difficulties, and heart defects may also be present.
There is some degree of mental retardation; however a large number of these children still have the essential skills needed to live a normal life.
Cleft lip and palate
This is another common condition, that these days are detected when the baby is in the womb.
It is not clear what the cause of this condition is. Children with cleft lip and palate have a slit present in the upper lip that can extend into the nose and the palate in severe cases.
The cleft is a result of failure of fusion of the left and the right sides of the lip and palate during embryonic development.
Children with this condition may have difficulty feeding and difficulty speaking.
However, surgical correction of the defect is possible around 3 months of age for cleft lip, and between 6 months to a year for cleft palate. Scarring is minimal and quality of life is normal after repair.
Club foot
This condition is common in boys, and occurs in 1 in 400 births worldwide.
It is a deformity of the feet and ankles, resulting in the foot getting ‘folded inwards’ to look like the end of a club.
Mild cases are usually painless, but severe club foot can be quite painful.
Once detected, treatment usually involves gentle correction of the defect using different manoeuvres and exercises.
Severe cases may require plaster casts or special shoes that have to worn up to 6 months of age.
Spina Bifida
This is an uncommon condition and is characterised by the presence of defect in the lower part of the spinal column.
Spina bifida is described as a neural tube defect. A neural tube is a precursor in the development of the spinal column, and defects in this structure can now be detected sooner through fetal ultrasound scans that are performed during pregnancy.
The condition may be harmless, though some children may have problems with bowel and bladder control.
Surgical correction may be performed within the first 2 days of birth, and physical therapy may be needed in the future to allow for normal mobility.
What To Do As A Parent
If your child has a birth defect, do not panic.
Modern treatments have made it possible for children with birth defects to have completely normal lives.
Make sure you get the advice you need from a pediatrician who will guide you regarding the future and prepare you for any situations you may encounter.
It is important for all pregnant women to get their ultrasound scans done as scheduled as these can pick up serious problems even before the baby is born.
For more academic articles by Dr Vivek Baliga, click here.
Frozen Shoulder – Keeping it Moving
Frozen shoulder – do you suffer from this problem?
In our practice, we often see patients who complain of a painful shoulder joint, especially when they try to lift their arm up.
This limited movement of the shoulder is sometimes called a frozen shoulder. Here we discuss this condition in a bit more detail, touching up on what you can do to help relieve the pain.
What Is A Frozen Shoulder?
Frozen shoulder is also called ‘adhesive capsulitis’.
This literally means that the cartilage capsule in the shoulder that protects the joint is very sticky and does not allow for smooth movement.
The shoulder is basically stiff and painful and is limited in movement. This can no doubt have an impact on the patient’s ability to perform their daily tasks.
What Causes A Frozen Shoulder?
There are a number of different causes that have been identified that can lead to frozen shoulder. But before we do that, let’s take a quick look at the shoulder joint. Read more
Low blood sugar levels? Here is what to do….
September 3, 2013
Diabetes, Dr Vivek Baliga, General
diabetes, glucometer, hypoglycemia, hypoglycemia unawareness, low blood sugar
If you are suffering from diabetes and have been taking treatment for it, you would know that missing meals or taking too much insulin or to many tablets can cause the blood sugar levels to drop to a dangerously low level. Such a situation is called hypoglycaemia. Hypoglycaemia requires urgent treatment as low blood sugar levels can have an impact on the functioning of the brain and other vital organ systems.
In this article, we shall briefly review the steps that patients must take in case they feel that their blood sugar levels are low or the reading on the glucometer demonstrates very low blood sugar levels. But before we discuss that, it is important to recognise what exactly hypoglycaemia is and what the symptoms that the patient experiences can be.
What is hypoglycaemia?
Hypoglycaemia is defined as a blood sugar level of less than 70 mg/dl on a fasting blood test. The normal blood glucose levels lie between 80 to 100 mg/dl. It is maintained at this level by the food that we eat at meal times and by the secretion of insulin from the pancreas into the bloodstream. In patients with diabetes, missing a meal can result in the blood sugar levels dropping remarkably low. In addition, if a patient misses a meal and still takes the medication required for diabetes such as tablets or insulin, this can drop the blood sugar levels dangerously low. This requires urgent treatment.
Chest Pain – It’s Not Always Due To Heart Disease
August 24, 2013
Chest pain, Dr Vivek Baliga, General
chest pain, dr vivek baliga, embolism, non cardiac chest pain, pneumonia, rib pain
Chest pain is a common reason for patients to visit their doctor. Many a time they worry what might be the cause of the pain, and in particular worry whether it may be a heart attack.
This worry and anxiety is natural. It may be reassuring to know that not all chest pain is due to the heart, and there are a number of other causes as well. This sort of pain is called non cardiac chest pain. However, if you do suffer from chest pain, rather than think it could be due to these other causes, we STRONGLY RECOMMEND you see your doctor straight away for further advice.
Here are some points on how to manage acute chest pain.
Right, so lets see what the other causes for chest pain are. We will not be talking about heart attacks or heart related pain here.
1. Gastro-Esophageal Reflux Disease (GERD)
Gastro-esophageal reflux disease (gastro = stomach, esophagus = food pipe), also called GERD, heartburn or acid reflux disease is the most common cause of non cardiac chest pain seen in clinical practice. Millions of people all over India and in the South Asian countries suffer from this condition. This is well recognised as one of the commonest causes of non-cardiac chest pain.
Patients with GERD often complain of chest pain behind the breast bone. The pain is typically ‘burning’ in nature, and patients state that they experience increased episodes of burping and ‘acid in the mouth’. Patients also tend to salivate more. The symptoms are worse after a heavy meal and when lying down flat. This history is fairly classic of this condition. Read more
Alcohol and your heart
August 14, 2013
Dr Vivek Baliga, Heart disease, Risk factors
Alcohol, effects of alcohol on heart, heart and alcohol
Many of us enjoy a drink or two once in a while. It does not cause any harm, and can be rather relaxing after a long days work.
But alcohol bears the power of taking over your life – it can become an addiction to a point where it starts to exert its bad effects on different vital systems of the body. And the heart is one of them.
But how does alcohol effect the heart? Let’s take a look at this a bit further.
Effects of alcohol on the heart
Alcohol can affect the heart in a variety of ways, but most importantly it can increase the chances of developing different risk factors that lead to heart disease. Consuming alcohol in moderation is generally okay, but once it crosses a limit, it can start to have damaging effects. It is not possible to state in any way as to who may develop these harmful effects from alcohol, so the general recommendation from the American Heart Association is the not start drinking alcohol if you have never touched a drop before.
Some of the cardiovascular effects of drinking large amounts of alcohol include –
- Diabetes mellitus
- High blood pressure
- High blood triglyceride level (a type of fat in the blood similar to cholesterol)
- Weakening of the heart muscle called cardiomyopathy
- Weight gain and obesity
- Irregular heart rhythms such as atrial fibrillation
- Sudden cardiac death
It is evident that the long term effects are many, and with continuing high consumption of alcohol, death is inevitable at a young age. Read more
Fatty liver – What is it?
If you have recently undergone an ultrasound scan of your abdomen, you may find that the report states that you have a ‘fatty liver’. A lot of our patients tend to get concerned regarding this, so we thought it best to briefly discuss what a fatty liver actually is.
What is fatty liver?
As the name suggests, fatty liver refers to the deposition of fat on the surface of the liver. In the medical world, it is also called Non – Alcoholic Fatty Liver Disease (NAFLD). Fatty liver can also be caused due to alcohol – this has not been discussed here, but will be discussed in our future blog posts.
Fatty liver – Fat deposits are clearly seen on the liver.
Bilateral pedal edema – Are both your legs swollen?
August 12, 2013
Dr Vivek Baliga, Heart failure
fluid in the legs, heart failure, leg swelling, legs swollen, swollen legs
Pedal edema, also called leg swelling, is a common problem. Learn more about it in this article.
A large number of patients who come to see us at our practice often complain that their legs are swollen. The swelling is often painless but can be rather troublesome, interfering with their daily activity.
Swelling of both the legs due to accumulation of fluid is called pedal edema. There can be a number of reasons why a patient could develop pedal edema and in this article, we shall take a look at this a bit further.
What causes pedal edema?
The most common reason why pedal edema develops is because of a reaction to inflammation or injury. Patients may notice that their legs are swollen if they have bumped up against a table, twisted ankle or have developed some form of skin infection. Of course, these are not the only causes for pedal edema and it can result from a number of different medical conditions as well. Let’s take a look at this a bit further. Read more
Understanding Haemoglobin A-1C (HB A1C)
Diabetes mellitus is a common clinical condition that forms a risk factor for the development of heart disease and stroke. If you suffer from diabetes and have been on treatment for a while, you may undergo regular blood tests to determine how well your blood sugar levels have been controlled with treatment.
The common tests that are performed include fasting blood sugar, post prandial blood sugar (i.e blood sugar test 2 hours after a meal) and heaemoglobin A1c (HbA1c). In this article, we briefly cover HbA1c.
Managing a collapsed family member..
It is not unheard of – you are sat at home watching the television when a family member starts to feel a bit light-headed and dizzy. They start to stumble and eventually collapse in a heap onto the floor.
Undoubtedly and naturally, you panic.
You rush straight towards them, sit them up straight away, get them a glass of water, and hope that they recover quickly.
Unfortunately this is NOT the way to handle a person who has collapsed. Let us see why.
