Good Bye Bypass Surgery Welcome Natural Bypass

By Dr. Bimal Chhajer

Dr. Bimal Chhajer MBBS, MD, Heart Care & Lifestyle Expert, is one of the pioneers and one of the most popular names in the field of Non Invasive Cardiology in India and abroad. He is the founder of Saaol (Science and Art of Living) Heart Center - the largest of the non invasive clinics all over the world. He completed his MBBS from Kolkata in 1986, MD from Lucknow and worked in the All India Institute of Medical Sciences (AIIMS), New Delhi for six years. In 1995, he resigned from the AIIMS as a faculty member and started Saaol. He is opposed to the concept of Bypass Surgery or Angioplasty and trains people on lifestyle change along with optimum medical drug therapy. He runs ECP clinics in more than 30 cities of India, Nepal and Bangladesh. His books and DVDs on heart care are bestsellers and his "Zero Oil Cooking" is very popular in India. He has authored about 100 books. Many of his books have been translated into 9 languages. He has received numerous awards and has treated more than 50,000 heart patients successfully without Bypass Surgery/Angioplasty.

• Language: English
• Publisher: Diamond Books
• Release date: Apr 15, 2021
• ISBN: 9789351652991

Book preview

Therapy

Part - I

Chapter 1

Introduction to Heart Disease

What is heart disease?

Heart disease is the gradual built up of excess fats inside the (blood flowing) tubes to the heart muscles.

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These blocks built up very slowly and when these tubes get 70-80% blocked does not get adequate blood - leading to chest pain, choking, suffocation or breathlessness. These symptoms manifest more when the patient/heart requires more blood while walking or running. The names of the fats which deposit are Cholesterol and Triglycerides.

This kind of Heart disease caused by these blockages is called Coronary Heart Disease (CHD). The same disease has other names also. These are Ischaemic Heart Disease (IHD), Coronary Artery disease (CAD), Angina pectoris, Angina, Ischaemia and so on.

There are more than 10 crore (100 million) heart patients in India – out of them 98% of heart disease fall into this category. Two percent have valvular defects and septal defects (hole in the heart).

What is heart attack and how does it happen?

Heart attack happens when the heart tubes (the tubes which supply blood to the heart muscles) have 100% blockage. In medical language heart attack is called Myocardial Infarction or Acute Myocardial infarction. It also can be called Cardiac arrest.

Most of the heart attacks occur suddenly and without any warning – when a blood clot lodges in the space between the blockage and the wall of the tubes. The cause of the blood clot is the chemicals released by the rupture of the membrane (Intimal membrane, Endothelium) which cover the blockages – which break due to continuously accumulating fats inside the blockage. It is like the breaking of a rubber band on a bundle of notes – as you keep on adding notes inside the rubber band. It takes about two minutes to clot the blood, which was flowing through the tube. This leads to a 100% blockage and stops the blood supply completely.

During heart attack patients get severe chest pain with breathlessness at rest. The portion of the heart muscles which do not get blood due to this 100% blockages starts dying immediately. If the area involved is big – the patient may also die. Around 40-50 lakh people die in India every year due to heart attack.

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What are the causes of Heart attack?

If we analyse more deeply, the membrane that covers the blockage (called Intima in medical language) is being stretched due to gradual accumulation of fats inside it. Heart attack occurs when eventually the membrane reaches its last stage and ruptures. The broken or injured membrane releases chemicals and the clot forms.

The breakage of the membrane depends on the strength of the membrane – in some patients it may not break till 90% blockage but in some it may break at 50% blockage.

So, the basic cause is the gradual accumulation of fats – namely the Cholesterol and Triglycerides. These two types of fats are the main criminals.

How to prevent or stop heart attack?

The simple answer is - by preventing further accumulation of these fats –namely Cholesterol and Triglycerides. If we can stop the supply of these two types of fats to the body and keep their blood levels at the lowest (Cholesterol below 130mg/dl and Triglycerides below 100mg/dl) – heart attack cannot happen.

So the aim of the patients should be to educate themselves about these two kinds of fat and avoid them.

When does the patient come to know about heart disease?

The tubes which take blood to the heart muscles (called Coronary arteries – the LAD, the RCA and LCX) have 70-80% extra blood than the heart’s need. Heart needs only 10-30% but the supply is 100%. This 70-80% is the reserve. So, heart patients will come to know about the shortage when the blocks cross 70-80% level. It usually takes 30-40 years to built this much blockage, but some people with bad lifestyle can complete the job in 10-15 years.

The complaints that the heart patients have, after the blockage of 80% or more, is called Angina. This can be chest pain or heaviness felt on the left side of the chest – increasing while walking or on exertion and are relieved on rest. Some people with angina may not have pain but may complain of breathlessness, uneasiness, burning sensation in the middle of chest or just palpitation.

Many people come to know about heart disease when they have 100% blockage following rupture of the membrane covering the blockage. These people will have the severe angina symptoms even at rest. Perspiration, sinking feeling or even collapse may happen during severe heart attack.

SYMPTOMS OF ANGINA

Breathlessness

Uneasiness

Substernal chest pain on exertion/Heaviness

Burning Sensation

Perspiration

Sinking Feeling

How to identify heart disease before a heart attack?

Heart attack (medically known as Myocardial Infarction) may occur anytime after the blockages grow above 50% level. The membrane can rupture at 50-70% level if it is weak. Such patient will not know that he had any blockage before the heart attack – as less than 70% blockage does not give any symptom. But these blockages can be easily detected by a non invasive test called CT Coronary Angiography in two minutes. This test is now widely available in India and is becoming popular.

But after the block crosses 70-80% angina may happen and can be detected with TMT (exercise stress test) or again by CT angiography.

If we can detect heart blockage before the heart attack we can remove the causes of the blockages and prevent the heart attack.

What to do when heart disease is detected only after a heart attack?

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At the time of the heart attack – the blockage was 50-90% but the clot has formed which has blocked the tube by 100%. Immediately the area of the heart will start dying. The patient will have severe chest pain or breathlessness in most cases. The patient should be immediately moved to a hospital and the doctors should try to break the blockages as soon as possible. If that is successful the area of the heart can be saved from dying.

So, the aim should be to shift the patient to a hospital as soon as possible. Before that a sorbitrate tablet can be given below the tongue and a tab of Despirin/Aspirin can be given as a precaution to the patient. Early recognition of the heart attack is very important and can save the heart muscles and death from a heart attack.

So, people are advised to prevent heart attack and to prevent the risk of heart attack.

What is the most ideal treatment of heart attack in a hospital?

As soon as a heart attack patient reaches a hospital – the diagnosis can be confirmed with an ECG and a troponin I test (a slide test for heart attack like pregnancy test). If the heart attack has happened within 15 minutes to one hour an immediate injection of a Clot busting drug (like Streptokinase, urokinase) can be given to the patient which may break the clot and save the heart muscles from dying. The hospitals should also perform cardiac enzyme tests, echo cardiogram to assess the severity of the heart attack. Oxygen, continuous heart monitoring can be started and other appropriate drugs should start to make sure that the heart does not stop and keep on working smoothly.

In some cases if the patient reaches within one hour or so an emergency angioplasty (called Primary angioplasty) can be tried by an experienced cardiologist.

What are the main causes of Heart disease?

The two major items that cause the blockages are Cholesterol and Triglycerides. Increased blood level and increased consumption of both the items increase the speed of blockages. The blood level cholesterol (serum Cholesterol) levels above 150mg/dl and Triglyceride level of more than 130mg/dl would lead to speedy increase of blockages. These two kinds of fats can be called mafia – as they lead to death of millions of people every year in the whole world.

Despite this, many cardiologists allow the Cholesterol levels above 180mg/l and Triglycerides above 160mg/dl.

Causes of Heart Disease

What are HDL, LDL and VLDL?

They are members of the lipid family and can be considered brothers and sisters of Cholesterol and Triglycerides. All of them you will be seen in your lipid profile report.

Among them HDL(High Density Cholesterol) is called good Cholesterol – as it can overpower removal of Cholesterol from the blocks if the concentration of it is more than 25% of Cholesterol level of blood. This is called Cholesterol HDL ratio. HDL is not available in the market or in any food - itcan only be manufactured in the body and can be increased by walking, stress management and consumption of green vegetables. Blood level above 40mg/dl of HDL is desirable.

VLDL (Very Low Density Lipoprotein) is just one fifth of Triglycerides and can be calculated easily by laboratories.

LDL (Low Density Lipoprotein) is another member of lipid family who follow Cholesterol. They are also influenced by Triglycerides and HDL. It is calculated as [Cholesterol – Triglycerides/5 – HDL]. (Please try this formula in your blood report and confirm). If the Cholesterol increases, LDL also increases. If one wants to prevent or reverse the blockages, LDL level in the serum (blood) should be less than 70mg/dl.

If you go into more details of the blockage formation – a lot more complicated process is to be discussed. Both Cholesterol and Triglycerides are packed inside the LDL which helps to carry them in the blood. When Oxygen combines with the LDL it is called Oxidized LDL Cholesterol - this deposits very fast on the wall of the heart tubes or coronary vessels. This process is called Atherosclerosis. For the purpose of making the explanation less complicated – I have avoided detailed medical mechanism of atherosclerosis process.

What other things influence and speed up the blockages in the heart?

Six more factors or conditions help the lipid family to build up the blockages – these are high Blood pressure, high blood sugar, tobacco consumption (smoking or Zarda, Gutkaetc), mental stress, alcohol and over weight (called Obesity). They all help Cholesterol and Triglycerides to get deposited faster.

Lack of three more factors also help in the built up of blockages – these are Exercise or walking, fiber and antioxidants (vitamins and some more useful food items) in the food.

How to diagnose heart Disease?

If the symptom is Angina, the blockages must have crossed 70% level. But some simple medical tests like ECG, TMT, Echocardiogram, lipid profile are helpful in diagnosing Heart disease.

The location and the extent of the blockages can further be confirmed by putting a dye inside the coronary tubes and taking X rays. This test is called Angiogram. Now a days two kinds of Angiograms are available – invasive type and non invasive type. The invasive one – mostly preferred by the cardiologists – is more risky and needs admission to the hospital. It is called Catheter Angiogram or conventional angiogram. But the latest technology has changed the art of Angiography- it is called CT Angiography. This is easy and non invasive.

What are these tests called ECG, TMT, Echocardiogram?

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In ECG – electrocardiogram – electrical recording of the heart is done while the patient lies down. Is would show problems/defects usually if there is chest pain/angina while lying down. It is useful when the patient has pain at rest. ECG reports can be normal even if the blocks are 90%. During heart attack, when the patient has pain at rest, ECG is most useful.

TMT or Exercise Stress Test is basically taking ECG while the patient increases the heart’s speed by walking. Heart’s usual requirement blood is 10%, 20% and 30% - when the patient is at rest, walking or running respectively. The machine is programmed in such way that the patient will slowly walk for sometime, then increase the speed and ultimately walk in almost running speed. The machine is stopped usually when the ECG shows change (when heart gets short of oxygen or blood). This test, thus can diagnose blocks in the heart tubes only after 70%. If the block is below 70% TMT may be normal. TMT cannot tell the exact location or percentage of blockages.

General Tests To Diagnose CAD

ECG

Lipid Profile

Echocardiogram

TMT

CT Coronary Angiogram

Echocardiogram – is basically sonography or ultrasongraphy of the heart. It cannot tell the blockages, but can detect past heart attacks and the extent of heart damage (minor or major heart attack). It gives the pumping power of the heart – EF or LVEF. It is usually 60% - but reduces after a heart attack. After minor heart attacks LVEF can reduce to 50-55% while after major heart attacks it goes down to below 45%. Echocardiogram is the best tool to diagnose heart holes and valve defects.

What is CT Coronary Angiography?

CT Coronary angiography is the most important advancement that the medical science has got in the last two decades. It can diagnose the percentage and location of the coronary blockages within one minute non-invasively. Previously there was only one option – the catheter angiogram, where a one meter wire (catheter) needed to be introduced inside the body and hospitalise the patient (because of chances of death, numerous complications). The cost was more with catheter angiogram.

Now with the CT Coronary angiography it is very easy to correctly diagnose the extent of the blocks. The most important advantage is that it is non invasive. Reports are as good as conventional invasive, catheter angiogram. Another advantage of CT angiography is that it is done by the radiologists who just can give an unbiased report and have no interest in the future treatment. In catheter angiogram – the cardiologists not only over diagnose the disease but also force the admitted patient and relatives to agree for a bypass surgery or Angioplasty. This is one of the reasons heart hospital cardiologists do not give a good opinion – when patients enquire about the friendly CT angiogram.

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What are the most common treatments of Coronary heart disease in the heart hospitals?

Mainly driven by the economic consideration – the cardiologists and surgeons working in the heart hospitals have completely overturned the treatment of coronary heart disease. Instead of solving the causes of blockages, the process of deposition of fats – they plan to operate on the heart patients. The common sense that diseases must be treated by removing the causes of the disease – have been purposefully altered for economic gains. They prefer two types of invasive solutions called Bypass Surgery (called CABG or Coronary Artery Bypass Surgery) and Angioplasty/stenting (Called PCI or PTCA – Percutaneous Transluminal Coronary Angioplasty).

In the first, a very complicated operation is done where a tube is removed from another part of the body and stitched on the blocked tube – thereby creating a parallel tube in the heart. Being highly invasive and having more operative complications the importance of this treatment is gradually going down – all over the world.

In the second, called Angioplasty, the blocked tubes are opened by inserting a long wire (called Catheter) inside the body and inflating a balloon at the site of the blockage. This was called Balloon Angioplasty. It failed badly as the compressed blockages came back very fast as soon as the balloon was removed due to elastic recoil. After few years when millions of cases failed, cardiologists came up with a small metallic spring/hollow tube (called Stent) which was fitted inside the compressed blockages to prevent the recoil or collapse of the wall. This was called Stenting. This also failed badly – as more and more fats deposited inside the foreign body and around it. To solve this menace they tried to change the stents – making is coated with drugs, which also failed badly.

Both the surgeries/invasive procedures are very lucrative as it leads to huge income for the heart hospitals and the cardiologists/surgeons. This is why they push the patients towards these temporary procedures – knowing very well the patients would like to go for a non invasive option if they are given a choice. They often threaten the patients and compel them towards these two surgeries.

Why Bypass surgery or angioplasty is not a good treatment?

The main problems of the two treatments are that they cut or puncture the body – which is the best machine of the world – much better than any man-made machines. Anything made by nature should best be left undisturbed. [While the initial blockage (undisturbed body) took 30-40 years to grow – blocks come back within months or few years after these operations (disturbed body).] Repeat bypass surgery is very common but repeat angioplasties are rampant. We get people with 9 stents in 3 years, 12 stents in 5 years and so on.

Bypass surgery is still better but angioplasties are a major failure on the part of medical science. In the last 20 years – the procedures of angioplasty has changed as the failure occurred every time. Starting from simple ballooning, simple stents, radioactive stents, gold stent, medicated stents to laser angioplasty, rota bladder – all of them has failed miserably. But due to the enormous profits that they make – the interventional cardiologists have time again come back with a new procedure. The patients have been taken for ride. The cost of a two gram stainless steel spring has been inflated to few lacs! Nobody wants to pay so much - but the fear and panic created artificially by the doctors in the heart hospitals make the kill.

Bypass surgery lasts longer – but it is a major surgery and with more complications. People suffer badly.

So, what are the options for heart patients?

The option is very clear and has four steps.

First, remove the causes of heart disease by lifestyle changes and diet modifications. This includes exercise, stress management, Yoga, Zero oil cooking, giving up tobacco and alcohol and so on. Eating more fiber and antioxidants are also very important. Avoiding high Cholesterol animal foods are also very much part of the lifestyle advice for a confirmed heart patient.

Second, give the patients conservative medical management by giving them standard medical drugs like vasodilators, thinners, betablockers, calcium channel blockers, Ace inhibitors and lipid lowering drugs. They make the patients safe and lower the risks of heart attack.

The third step is ECP or Natural Bypass. In this treatment, the second set of tube (called Collateral Circulation) in the heart are opened by increasing the coronary flow by pneumatically compressing a series of cuffs wrapped around the lower limbs of the body. This technology has taken about 60 years to develop, is non invasive and scientifically proven and effective method of treating heart disease within a short time of 35 days.

The fourth step is use all the other possible non invasive methods like EDTA injections/oral supplements, Ayurveda, Homeopathy, Unani - each may contribute to removal of the disease non invasively. The possibilities are enormous.

[This is what Saaol (Science And Art Of Living) does.]

Chapter 2

What is ECP?

What does ECP mean ?

ECP

Non Invasive

Non Surgical

Out Patient

Device Based

Clinically Proven

Safe

Cost Eff ective

The abbreviation ECP stands for External Counter Pulsation. [ECP is a non-invasive, device based, outpatient treatment for heart disease that is used to relieve or eliminate angina. It is a clinically proven, safe and cost effective treatment for coronary heart disease. During the treatment, blood pressure cuffs are wrapped around your legs, squeezed and released in synchronisation with your heartbeat, promoting blood flow throughout your body and particularly to your heart. In the process, ECP develops new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels (collaterals) that help increase and normalize blood flow to the heart muscle. These tiny but numerous blood tubes were present since birth in our heart as a natural reserve. When opened by this pressure treatment they serve as a second conduit (bypass) for blood supply to the heart. For this reason, it is often called the natural bypass. Arteriogenesis is the latest and new medical term used to define collateral formation.

ECP vs EECP vs Natural Bypass

ECP has many names – as each of the users and manufacturers gives it different names. As the system opens the natural tubes of the heart, which were till now dormant, it can be called Natural Bypass or Natural Bypass Therapy. If you look from the angle of how it works – it creates just the opposite of what heart does by pumping blood – called the pulse. So, it is popularly called Counter Pulsation – just the opposite of pulse. Since it is done by an external device – it can be called External Counter Pulsation (ECP). Since during ECP the cuffs pump sequentially – it is also called SECP (Sequential ECP). To emphasize that their machines have extra effectiveness – Vasomedical company, the main US based manufacturer coined a name called Enhanced External Counter Pulsation (EECP). They also got it patented and this name has been used by most of the researchers in USA who used Vaso medical made ECP machines. At Saaol we have coined a name called PAN B – Pneumatically Assisted Natural Bypass. This PAN Bypass name looks more scientific. There is another manufacturer who calls it IECP (Increased External Counter Pulsation). However the technology of the machine remains the same or at least similar – so, a single name is more appreciable. Because of the monopoly of Vasomedical for so many years in USA - the term EECP was very widespread. But gradually other manufacturers also came and became popular and most of the machine manufacturers use the term ECP.

The trademarked term EECP (Enhanced External Counterpulsation Therapy) is significant to note because this term is used only when referring to therapy delivered on products (devices) made by the registered trademark holder VasomedicalInc (or personnel thereof). This common use of EECP should not be confused with the technical term of the treatment which is called External CounterPulsation Therapy or ECP Therapy for short. Both ECP Therapy and EECP Therapy are FDA approved and covered by Medicare and private insurance in the United States.

What is the main mechanism of action of ECP therapy?

Our body is the best machine of the world. It can be called the best product of Mother Nature. If we believe that God has made the body – He must be a super engineer. The whole of the medical community has worked so hard for the past hundreds of years and still has been unable to know how it works in completeness.

Every day a new mechanism of its working is found out by the researchers – even after so many years of advanced research. Think of the engineer of this machine who gave it enzymes, hormones, neuro transmitters, cells, nucleus, DNA, RNA, ribosomes, and so on. All these have to work together to make the body working 24 hours, seven days a week flawlessly. The medical scientists discovered drugs to modify the functions of the body and treat them temporarily. But each of them have side effects. Cutting the body by the doctors is again a process that definitely has some known and unknown complications. Heart is one of the most important organs of the body and has to work non stop until death. So, it is definite that permanent surgical interventions are bound to have complications and side effects.

For each of the organs the body has provided a huge reserve. One eighth of the liver is good enough to keep the body working. One kidney is sufficient – but one more has been given. So, one can donate a kidney. Similarly in the heart the coronary tubes have been given 70-80% extra blood supply (this is why the heart tubes need to be blocked by at least 70% to create problems). In addition, heart has been provided a complete extra set of tubes which are small but inter connected.

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These are called capillaries and there are millions of them. These capillaries are mostly not used and lie dormant in every heart. ECP opens these dormant capillary circulations. This is called opening of the collateral circulation.

This can be done within a period of few weeks by a sleek, non invasive machine which is easy to handle, completely safe and inexpensive. This treatment can be given as an out-patient treatment and patients need not be admitted to a hospital thus decreasing the chances of infection called Hospital acquired infection).

For obvious reasons ECP has gradually gained popularity and since the scientific research has proved it to be an effective treatment – even the medical community cannot say no to it.

How popular is the ECP treatment?

After 50 to 60 years of research and development ECP therapy is now completely established method of treatment of heart disease. In the United States of America (USA) it is already a common treatment offered in the heart hospitals. It is not only approved by the FDA (Federal Drug Administration) but insurance companies have also approved it for reimbursement in the USA. The allowed cost of a single ECP therapy by the insurance companies range from US dollar 125-200. The whole treatment cost is now about 6000 to 7000 dollars. Now, about 1200 ECP machines are in the working all over the USA treating heart disease non invasively. A list of prominent Hospitals which have ECP therapy is provided here. Many of them are called EECP centers as Vasomedical (the most popular ECP manufacturer in the USA) uses this term to develop their branding.

USA – FDA approval is the most stringent