The effect of Climate Change on CardioVascular diseases – Chawm Ganguly

chawm gangulyThe Earth is heating up. The polar caps are melting, resulting in the gradual rise in the sea levels, which, in turn, promises to play havoc with the world as we know it today. Already, the summers are prolonged, the winters are harsher and the monsoons are erratic. Water tables are being depleted at an alarming rate; deserts are advancing menacingly, while cloudbursts are threatening to wash away much more than our sins. Cyclones and Tsunamis have started baring their devastating fangs with increasing frequencies. Anthropocene man, in his quest to play God over the elements, has unleashed upon himself the twin wraths of Global Warming and Climate Change. And, that is only the tip of the proverbial iceberg.

Changing climatic conditions are also, largely unnoticed by us, helping spread diseases that are not only mutating to assume deadlier forms, but also becoming increasingly resistant to our efforts to contain or eradicate them. Modern Man’s obsession with instant gratification and his all encompassing quest for conspicuous consumption too, are adding to the woes, making them attain proportions that may soon spin out of control.

Take cardio-vascular ailments for example. The very basic requirements for maintaining good health in general and a healthy, thriving heart in particular – clean (read unpolluted) air, access to fresh drinking water, sufficient “healthy” food, adequate shelter and a peaceful, stress free habitat – are all more or less, endangered today, thanks to the menace of climate change. Add to it the “benefits” whose pursuit has brought us to this pass – sedentary, desk-bound lifestyles with little or no physical exercise; extreme incidence of stress and strain; untenable and unhealthy food habits and constant substance abuse, be that tobacco or alcohol and the pot, like they say, brimmeth over.

It is well established that extreme temperatures – be that heat or cold – increase the incidences of heart related disorders and diseases like dysrhythmias and strokes.

Similarly, increased Ozone formation brought about by higher temperatures harms pulmonary gas exchange and is known to cause stress on the heart. The relationship between increased Ozone concentrations and heart attacks too, are a known fact.

The increase in particulate matter, brought about by drought (and definitely pollution), leads to systematic inflammation, compromises the heart’s functions and has been identified as one of the root causes of deep venous thrombosis, blood vessel dysfunctions and pulmonary embolism among others.

Certain vector borne and Zoonotic diseases like Chagas or Lyme diseases are also having increased Cardio Vascular manifestations, brought about by the perpetration of Global warming and Climate Change.

Extreme weather events also bring upon, in their wake, unbearable amounts of stress and anxiety. For a population that is already suffering from a huge amount of tension and mental trauma, the natural outcome is a heart attack, stress-related cardiomyopathy or even cardiac failures.

However, considering the fact that the very awareness about the ill effects of climate change is of relatively recent origin, a substantial body of knowledge backed by irrefutable research, is unfortunately, conspicuous in its absence. Most of the linkages between the increased incidences of cardio  vascular conditions and climate change that are normally drawn, are therefore more conjectures (read experience backed hypothesis of the medical practitioners) than medically established facts and need to be studied in depth, the efficacy of which I need not over emphasise here.

For example, research on the incidence of cardiac dysrthythmias and its association with temperature spikes and other environmental exposures is still a grey area. Again, quality research on the complex synergistic effect of temperature, weather variability, long term climate change and environmental exposures to various pollutants, on cardio vascular disease outcomes, need to be studied in detail with immediate effect.

Without going into the details, let us concentrate on only one problem area. We are all aware that water tables are going down even as there is an increasing flow of people crowding our urban centers. Naturally, such migrations increasingly throw up stiffer challenges of providing safe drinking water to the masses, which in India, is already exposed to unacceptably high levels of water borne diseases. Do we have enough knowledge to establish a co-relation between the effect of water borne diseases and cardiovascular ones? But even more importantly, the moot questions is, do we care enough?

Cardiology an indicative Timeline

  • 1628 – English Doctor William Harvey describes the systemic circulation and properties of blood that is pumped to the entire body by the heart. However, Ibn al-Nafis (1213-1288) an Arab physician is credited with explaining blood circulation centuries before Harvey.
  • 1706Raymond de Vieussens (1635-1715), gives accurate descriptions of the left ventricle and several blood vessels of the heart. Vieussens is remembered for his pioneer work in the field of cardiology, and his anatomical studies of the brain and spinal cord. He was also the first to give a comprehensive description of mitral stenosis, as well as other types of heart disease and circulatory
  • 1733Stephen Hales,(1677-1761), an English clergyman becomes the first person to measure blood pressure. He is revered for having made major contributions to a range of scientific fields including botany, pneumatic chemistry and physiology. He also invented several devices, including a ventilator, a pneumatic trough and a surgical forceps for the removal of bladder stones.
  • 1819René-Théophile-Hyacinthe Laennec (1781-1826) was a French physician invents the stethoscope , while working at the Hôpital Necker. He is also credited with having pioneered the use of the stethoscope in diagnosing various chest conditions.
  • 1903Willem Einthoven, a Dutch doctor and physiologist  invents the first practical electrocardiogram (ECG or EKG) in 1903. He was honoured with the Nobel Prize in Medicine in 1924 for his contribution to medical science.
  • 1912James Bryan Herrick (1861-1954), in a landmark article on myocardial infarction (“heart attack”) in JAMA proposes that thrombosis in the coronary artery leads to the symptoms and abnormalities of heart attacks and that this was not inevitably fatal. While Herrick was not the first to propose this, ultimately his article was the most influential, although at the time it received only limited attention. In 1918 he was one of the first to encourage electrocardiography in the diagnosis of myocardial infarction.
  • 1938 Robert E. Gross (1905-1988), performs the first ever heart surgery. He was an American surgeon and a medical researcher.He performed early work in pediatric heart surgery at Boston Children’s Hospital. Gross was president of the American Association for Thoracic Surgery, a member of the National Academy of Sciences and a fellow of the American Academy of Arts and Sciences.
  • 1952Charles Hufnagel (1916-1989), implants an aortic “assist” valve into the circulatory system of a 30-year-old woman. The valve consisted of a pea-size ball of plastic inside a chambered tube—an inch and a half long and an inch thick—that regulated blood flow through the heart. The manufactured valve compensated for the faulty original valve, but did not actually replace it, while ensuring that the heart was able to pump blood successfully into the body’s circulatory system.
  • 1952F. John Lewis, an American surgeon performs the first successful open heart operation, closing an atrial septal defect in a 5 year old girl, on September 2, 1952.[1] For the next 3 years, Lewis and colleagues operated on 60 patients with atrial septal defects using hypothermia and inflow occlusion.
  • 1953Dr. John H. Gibbon (born 1929) invents the heart-lung machine and performs subsequent open heart surgeries which revolutionized heart surgery in the twentieth century.
  • 1962James Jude,Guy Knickerbocker and Peter Safar create Training Video called the “Pulse of Life” detailing ventilation in the form of mouth-to-mouth resuscitation combined with chest compressions as a key part of resuscitation following cardiac arrest.
  • 1965 – Michael DeBakey and Adrian Kantrowitz implant mechanical devices to help a diseased heart.
  • 1967Christiaan Neethling Barnard(1922 – 2001)  a South African cardiac surgeon  performs the world’s first successful human-to-human heart transplant.
  • 1982William Castle DeVries (born December 19, 1943) an American cardiothoracic surgeon,   does a TAH (total artificial heart) transplant using the Jarvik-7 model which was  designed by a team including Willem Johan Kolff and Robert Jarvik.

(the piece was originally written for the Express Health Guide 2016)