For something so essential, the heart is remarkably easy to overlook; a curious paradox. It has fueled centuries of poetry and built entire careers for songwriters. We speak of giving it away, following it, protecting it, and, occasionally, having it broken.
Yet when it comes to the tireless muscle sustaining us day after day, many of us know surprisingly little.
For a long time, heart health felt like a concern reserved for later in life, something to be discussed alongside retirement plans and annual check-ups dutifully pencilled into diaries.
Today, however, the subject feels far more immediate. As our lives become increasingly fast-paced, caring for the heart has never been more important. Keen to better understand how we can protect the organ that works hardest of all, Masala visited Ruamjairak Hospital, known for its patient-centred approach and specialist expertise, to speak with Dr. Nivit Kalra, M.D. about prevention, risk factors, and the small daily habits that shape our long-term health.
What initially drew you to cardiovascular medicine as a specialty, and what continues to motivate you in the field today?
When I was in medical school, I was deciding on what speciality to go into. I realised that cardiology and interventional cardiology had become the last line of defence between life and death. As a general practitioner and resident, I saw firsthand that cardiologists are often the ones making decisive, life-altering interventions for patients in their most critical moments.
That sentiment piqued my interest in cardiology, but what sustains it is the field’s relentless pace. Cardiology is a constant horizon of new discoveries. We are always seeing better medications and smarter, less invasive treatments.
As a specialist in cardiovascular medicine, what are some of the most common heart health concerns you are currently seeing among Indian patients?
Among Indian patients, the concern keeps changing with the times. Back in the day, it was a late-stage battle against coronary artery disease. Today, the focus is increasingly on prevention and early detection, which is why more younger patients are being diagnosed with heart conditions.
This does not necessarily mean that heart disease is becoming more common among younger generations. Rather, people are paying closer attention to their cardiovascular health and undergoing screenings earlier. As a result, potential issues are being identified long before they become serious.
Early detection also does not automatically lead to invasive procedures. In many cases, intervention begins with lifestyle modifications and improved risk management, allowing patients to address concerns before they progress into more severe conditions.
There is often a culture of “pushing through” exhaustion or ignoring symptoms until they become serious. What are some early warning signs people should stop dismissing?
The early signs consist of being unable to do certain activities that you once used to do with ease. While many people attribute this change to ageing, it can sometimes signal an underlying heart condition related to the coronary arteries, heart valves, or even the heart muscle itself.
For this reason, persistent symptoms should not be ignored or dismissed as simply getting older. The effort required to consult a physician is minimal compared to the potential benefits of identifying and addressing a cardiovascular issue early.
From your experience, do cardiovascular conditions tend to be more hereditary, or are lifestyle choices usually the bigger contributing factor?
People often look for a single culprit when faced with a diagnosis, and it is natural to want to blame something beyond their control. So, a lot of patients like to say that this is a genetic condition.
However, heart conditions and heart health in general are not one-dimensional. Heart-related issues are influenced by a combination of factors, including genetics, lifestyle choices, and an individual’s environment and circumstances. Family history can certainly increase risk, but it should not be viewed as the sole explanation.
At what age do you believe people should begin monitoring their cardiovascular health more seriously, especially those with a family history?
The easiest way to discern when to begin monitoring one’s cardiovascular health is to consider what age the member of your family was diagnosed with a cardiovascular disease. Then, minus that age by 10.
For example, if parents or grandparents were diagnosed with heart disease at the age of 50, it means you start screenings from the age of 40. If they were diagnosed at the age of 45, then you start monitoring from 35 onwards.
For people in their twenties and thirties, what are the most important habits they should build now to protect their cardiovascular health later in life?
Make sure that you do some exercise weekly. The ideal time frame is about 150 minutes per week. According to multiple studies, that is the gold standard.
Lifestyle choices also play a crucial role. Avoiding smoking, limiting alcohol consumption, and getting adequate sleep can have a large impact on overall heart health.
Recently, there has been a positive change in younger generations towards healthier habits. Despite facing new sources of stress, many are turning to exercise, sport, and mindful eating as ways to cope.
Home-cooked meals remain best, offering nutritional quality and ingredient control that is difficult to replicate elsewhere.
For people currently dealing with cardiovascular issues, or at risk of developing them, are there any vitamins or supplements that may help support heart health?
Supplements that have shown they can improve heart health are vitamin E, fish oil, garlic, and Coenzyme Q10. These are the common ones that most people already know about, but there are a few more that actually do benefit the heart as well, such as astaxanthin and magnesium.
Looking ahead, what developments in cardiovascular medicine are you most excited or hopeful about?
Currently in cardiovascular diseases, especially arterial conditions, we have shifted from surgery serving as the primary treatment towards non-surgical or minimally invasive procedures.
We now also do Intravascular Ultrasound Technology (IVUS) as well as Intravascular Lithotripsy (IVL), which basically destroys the calcification around the heart artery. We do rotablation as well, a minimally invasive approach to removing hardened plaque from heart arteries. All of these procedures are meant to minimise the need for surgical procedures.
However, besides the coronary artery, there is also structural heart disease, which tackles the valves of the heart.
For the past five years, we have been conducting a procedure called Transcatheter Aortic Valve Implantation (TAVI), where we replace the aortic heart valve via catheter. The new aortic heart valve becomes part of the structural heart.
As for the electrophysiological part, we are doing a lot more atrial fibrillation treatment, which used to be medication only.
Now, we are implementing procedures to help as curative treatments too. We are excited that newer devices have been helping us prevent future complications and even reduce medication for patients. We are moving in a direction that will minimise long-term complications.
We are minimising long-term dependency and cost for patients. So I am excited about that. And I hope that in the future, there will eventually be tablet forms where we can just take one and then clear all the plaque and calcification in our hearts.