Heart failure - Enter the Emperor

Heart failure is a clinical syndrome where the heart fails to pump out enough blood to meet the body’s requirements and in particular when the body’s requirements are heightened. This may then manifest with symptoms of breathlessness, tiredness, and exercise intolerance. Virtually all forms of heart disease if left unchecked will eventually lead to heart failure. So if you have high blood pressure for a prolonged period of time and it remains unchecked, then eventually the patient will develop heart failure. Similarly heart attacks damage the heart and therefore affect the ability of the heart to pump blood put and this leads to heart failure.
Patients with heart failure will not have as good a quality of life as patients without heart failure and in general not live as long as patients with strong hearts.
SGLT-2 inhibitors are anti-diabetic drugs which have only over the past 5-10 years gained prominence because they were shown to reduce the development of heart failure in patients with Diabetes. Subsequently, further studies suggested that they reduced progression and improved prognosis in patients with heart failure (HEFREF) irrespective of whether the patient even had diabetes or not. 2 such agents (Dapagliflozin and Empaglifloxin) are now routinely given to all HEFREF patients as standard therapy because of the prognostic benefits that have been documented. So anyone watching this who has heart failure with a reduced ejection fraction who is not on an SGLT-2 inhibitor then I would very much recommend seeing your doctor and asking why you are not on it.
Given the benefits seen in HEFREF, the next step was to see whether these agents could help patients with HEFPEF and this led to the EMPEROR-Preserved study the results of which were published in the New England Journal of Medicine last year. In this double blind placebo controlled study, the investigators randomly assigned 5988 patients with symptomatic heart failure and patients with ejection fraction of more than 40% to receive wither placebo or an SGLT-2 inhibitor called Empagliflozin at a dose of 10 mg once daily in addition to usual therapy and they wanted to study whether there was a reduction in hospitalisations for heart failure or death to cardiovascular causes.
Over a median period of 26.2 months, an outcome vent occurred in 415 of 2997 patients on Empa and 511 of 2991 patients on placebo. 13.8 percent of the Empa population had to be hospitalised or died due to cardiovascular causes in comparison with 17.1% in patients on placebo. The NNT was 31. Much of the benefit was driven by reduced hospitalisations rather than mortality but even reduced hospitalisations is benefit very much worth considering.
The study was published in NEJM on the 14th October 2021 and the lead author is prof Stefan Anker.
So the main points that I wanted to make are:
1. The diagnosis of heart failure is a clinical diagnosis. ECHO can tell you if you have a significantly reduced ejection fraction but even if your EF is preserved, you can still have heart failure
2. SGLT-2 inhibitors are an exceptionally interesting new class of agent which may help in terms of improving prognosis in patients with heart failure regardless of ejection fraction.

[@dennisfrank1756]

Excellent presentation and presenter. My first cardiologist diagnosed ischemia and unstable angina. Started medications but got progressively weaker. Saw a second cardiologist. He diagnosed heart failure. Lungs were filled with fluid and EF 17%. I never knew there was such disparity in cardiologist quality.

[@NunalSaPaa]

Dr. Gupta, I'm now well and have gotten back to cycling because I followed your advice of increased salt intake for Long COVID. I was bedridden for almost 9 months and I really felt I was close to dying. You gave me my life back. You gave my children their mother back. Thank you so much.

[@vandanakerur9318]

@Nunal Sa Paa, can you please explain what is Long COVID? I have not heard of it. How did increased salt intake help? Why were you bedridden for 9 months? Sorry for asking such personal questions, I totally understand if you don't want to answer. But your comment makes me want to know more, and hopefully your answer will help those who are maybe having the same health issues. Thank you.

[@jameskantor0459]

@@vandanakerur9318 Long Covid , long term infliction of COVID 19 that does not get better even after months.

[@MarkKislich]

Increased salt intake? Could you elaborate?

[@vandanakerur9318]

@@jameskantor0459 Thank you

[@MiteshDamania]

Take the spike protein neutralizer from the wellness company. Long covid is due to spike protein presence

[@michellewelch6013]

So interesting, I’m determined to speak with my cardiologist intelligently rather than being brushed off as unable to comprehend what’s happening to my own body. Thank you!

[@gingerslush6301]

I love this doctor cardiologist.❤ He gives soothing information, light of hope to the hopeless.❤

[@kathryngannon485]

Dr Gupta I have watched many of your videos from years ago and I am quite astonished that you haven't changed at all. You obviously are a great example to us all. Thank you for your work.

[@Sun_Flower1]

Finding your channel has been a godsend. You provide the information and reassurance that my cardiologist is too busy to address. Thank you so much for taking the time to make these videos.

[@rover790]

I agree, a very big heartfelt thank you Doctor.

[@andrewhawkins8616]

More likely too insensitive and greedy. Cardiologists tend to make stupid amounts of money, which they can't do if you're not sick.

[@suecondon1685]

I've been suffering with breathlessness, fatigue, A fib, swelling of legs and stomach for years. I had rheumatic fever as a child, was diagnosed with mild atrial stenosis and mild mitral valve regurgitation over 20 years ago. I've seen a cardiologist for echo's every few years but they always said I was symptomless despite being so puffed out i now have to keep stopping in the street to get my breath. My quality of life is awful. I was just hospitalised over night with a bad episode of A Fib and the echo showed severe tricuspid regurgitation, and my heart is not contracting fully. I'm terrified and so upset that they ignored me for so long. My ejection fraction is 50% which they say is okay but it doesn't feel like it. I'm 65 and very scared. I have a cardiology appointment this week so will see what they say. Thank you so much for your wonderful videos.

[@shanes.9089]

Follow up? How are you doing now ? Were you put on Jardiance or any meds for help?

[@PeterCianci]

Praying for you....any updates?

[@sdjohnston67]

"Failure" seems like an inappropriate term. In ordinary experience, if a dynamic mechanical thing fails, it doesn't work anymore at all. (E.g. a failed bridge doesn't still partially work). Why is this called "failure" when in fact it actually indicates reduced function below a certain level? The psychological effect on a person who is told their heart has "failed" can itself be very damaging and badly impact their activity compared to what they should be doing for the best possible outcome. So often, it seems to me, medical conditions are misnomered, inducing a degree of catastrophising in people. (The term becomes a self-fulfilling prophecy). The psychological impact of what things are called and how they are medically described is taken too lightly by many medical professionals. Just making a general observation, not saying you are doing this, Dr. Gupta. [I love your channel and you have been very helpful to me.] An older member of my family hangs on every utterance of her GP and the slightest remark can make a significant long term impact on her entire mental perspective of her own status and capabilities. (And this can be, at times, disproportionately negative compared to the true reality of the situation, because of how a term is perceived. )

[@meaganreilly5819]

Thank you so much for this comment. My father (65 non smoker/drinker- obese builder- pre diabetic And hasn’t been in hospital since he was a teenager) has just been through the most traumatic 2 months of his life. We were under the assumption that he was just having a stent and then it progressed to a quadruple bypass. Thankfully he made it through but was discharged too early and he had a lot of breathing problems/ coughing up phlegm and swelling. After multiple calls to the hospital to see if this was normal, we took him to his GP to get the stitches out and a general consult. The GP took a look at my dad while he was out of breath and flippantly said “I think you have heart failure.” And moved on to the stitches. We lost our damn minds, I’ve never been through something so traumatic in my life and it has brought on panic attacks I haven’t had in years. My father is doing as well now as he can be at home but we will never be the same. To all Doctors…..THINK BEFORE YOU SPEAK!!!!!

[@sarita3337]

I agree. It’s a term that causes people to give up.

[@darwinhughey3861]

Yes!

[@anibabikian]

I have been a Pediatric ICU nurse in the US all my life and most of the info is not new to me, BUT, love watching you as as I learn to make it easier for me to explain things to family and friends in words they understand . ( I have them follow you but some need me to interpret). Thank you

[@onerider808]

Thanks for what you do, Ani. My ex has been an ICU (high level) nurse for years. What a tough job. I hope you are caring for yourself and get some pampering now and then. Caregivers often give so much of themselves, but ignore their own care, or are so busy caring they forget/don’t have time to perform that critical self-care.

[@anibabikian]

@@onerider808 I am not proud to say I never took care of myself… I exercised to cope but pampering? No! Just retired but I miss work tremendously! Thank you for the advice!

[@graemelindsay7328]

This video is very interesting Dr Sanjay and is serendipitous. I've been hospitalised 3 times in the past 8 weeks with unstable angina since having a stent placement 12 weeks ago. Each time I have been prescribed an increased dosage of nitrate. I'm not eligible for further stenosis as I have diffuse disease (calcification and >50% blockage) of LAD, D1, LCx and RCA. The ED doctor mentioned two nights ago that SGLT-2 drugs, particularly Dapagliflozin may benefit me. While SGLT-2 drugs are currently unfunded in NZ I will bring this information forward to me cardiologist, who I am seeing in 3 weeks. Serendipitous, yes, seriously worth investigating for me, yes! Thanks for sharing and caring Sanjay.

[@im1dc]

I so look forward to Dr Gupta's Tutorials, they are routinely superbly done and highly informative as well as helpful.

[@dr.sundar5013]

An extremely informative video !! Are there ways to increase EF without medications ? I mean by certain exercises or lifestyle modifications ?

[@chanelv5373]

Wow, this video just popped up in my feed today and today I was diagnosed with heart failure with an EF of 58% per recent echo. So timely for me. Thank you 😊

[@wilternbackstage]

58% EF is a good number…

[@DilanDilray123]

Not bad number

[@saratkumar2484]

Dr.Gupta, you have explained beautifully, even a layman can understand the topic. Thank You

[@pamelamorley6145]

Very interesting. I will be asking about the SGL 2 inhibitors. Thank you for all the time that you spend educating us all. Please don’t leave….we rely on you so much to keep us all posted! Happy Christmas to you and yours.

[@DRMICHELLEROSALIEELAUNO]

Thank you Dr. Gupta.. upload more videos...continue to be a blessing to many especially to patients. May GOD bless you always.

[@hedgehoghogtel1694]

Thank you for your videos, they're very helpful. My father was diagnosed with ischaemic heart failure in his early 70s a few years ago (no signs at all until he had a 'faint' and was investigated with various tests). However, he had high cholesterol and hypertension in his 40s, going on to have TIAs and strokes in his 50s, as well as having silent heart attacks somewhere in his life (leading to severe scarring of his left ventricle). To my knowledge, no echo was ever performed until his recent HF diagnosis. My sister in her early 30s was diagnosed with hypertension, and on a recent echo at the age of 40, she has a reduced ejection fraction for her age and hypokinesia of the septal wall. I too developed an atrial tachycardia in my early twenties (ongoing), and have mitral annular disjunction on a recent echo and grade 1 diastolic dysfunction of left ventricle). My question is, how can one differentiate between heart disease/failure that are familial/genetic and those that are purely ischaemic (especially in situations like my father where he was a late diagnosis)?

[@jeffreybaier5312]

You can sent up a zoom appointment with him. Just contact York Cardiology, I don't know the cost.

[@hedgehoghogtel1694]

@@jeffreybaier5312 Thank you.

[@omargdottin]

Great content; We appreciate your efforts of education and information 👍

[@kenbad8271]

Hello I have just come across your video on Slow heart rate or Bradycardia that you made 5 years ago and just wanted to say thank you very much for posting that video as I have a slow heart rate of 50 when I am sleeping or just relaxing and when I went for my sleep apnea test the specialist said she was concerned about it but did not suggest I do anything about it not even talk to my primary care doctor but now I am relieved to hear it's not a problem as long as I am not experiencing fainting or dizziness which I don't so thank you for this information I have just subscribed to your channel please keep the videos coming they are vital and necessary.

[@jamesblevins7115]

Thank you Sanjay always a pleasure hearing your lectures

[@OregonCrow]

I love your videos Dr Sanjay Gupta! I first came across your channel when looking around KZbin about Afib, which I've been having some out of control episodes the last few months. Hearing your advice on Vitamin C and trying it out, I have been episode free for almost a week now. So yea, THANK YOU! Quick question for you Dr Sanjay Gupta. What does a heart specialist do for his own heart after knowing so much information? Wondering if you have a video or can make one up about what a specialist does to take care of his own heart. When not taking care of others? Thank you Thank you Thank you! Cheers Take Care -Nick

[@ranjanarawat8285]

You explain so well.Really informative.

[@chrisb1682]

Thank you Dr Gupta and the best cardiology department! 🌿💕

[@triciawilliamson2081]

Thank you so much Dr. Gupta for your clear and detailed explanations.

[@soilsurvivor]

Another excellent video. I do have a qustion. In your discussion of patient outcomes in the Emperor study, you said the placebo group had a 17% hospitalization (or death) rate compared with 13% for the medicated group. That's a difference of 4%, which would infer 1 out of 25 patients given the drug would benefit. Yet, you said 1 out of 31. How did you (or the study?) arrive at that number?

[@JMJ3339]

Thank you Dr. Gupta! Your videos are very educational and useful!

[@susanforbes6129]

Thank you for video 🙏💜

[@kitwilton2938]

Dr Gupta, love your videos! I wonder my ejection fraction has improved from 20% to 33% in 6 months taking jardience and entresto. My question is odd. Can I go into a pool to “ splash about” or will that put added stress on my heart at this stage. I’d love your input as I’d love to be able to holiday and go into water.

[@shanes.9089]

Good news on your improved EF with those two medications question have you felt different or had any side effects from that cocktail? Also I assume they are monitoring your kidney function has that stayed normal? Happy they have worked for you I may be put on the same regiment is why I am asking thank you!

[@taneiap4962]

🥰🥰😍Dr. Gupta I love your videos you are just wonderful, thank you so much for your very helpful information to those of us who have heart related medical issues. Your videos always seem to calm me down when I have health anxiety🙏🙏🙏

[@ja6368]

Thank you for giving your time and such valuable information.

[@bill6872]

Thanks Doctor! I wish you were my cardiologist.

[@buster9106]

Thank you so much for this information! I'm in heart failure with reduced ejection fraction and I feel so bad for those people who haven't got a proper diagnosis because they have preserved ejection fraction. Heart failure is already a terrible thing to have to live with, but not even getting a proper diagnosis and treatment is horrible. I always thought the echocardiogram was the definitive diagnosis. But I think there is an overreliance on technology in a number of diagnostic tools. So now finally these people can start to get some help. I personally stopped the traditional cocktail of beta blockers, ace inhibitors, and diuretics because of the side effects. My biventricular pacemaker seems to be the only thing that has elevated my injection fraction from 20 to 45. But now I can have a different conversation with my cardiologist to see if these drugs for people with preserved ejection fraction might work for me.

[@thefuzzfactor2989]

I hope you get good news re the posdible help of this drug. I've only very recently been prescribed it (haven't begun yet). I hope this is good news for us all.

[@paulawagstaff686]

Thank you for your information. I had a pacemaker/defibrillator 8mths ago. EF 20 - 25% LV. I didn't know the EF could be increased, I just assumed it slowly deteriated. I am amazed you went off your drugs, didn't even know that was possible. I am currently gathering info on K2 MK7/D3, & Hawthorne, to take with my drugs, plus I just stopped stations to replace with Berberine, oats/ceylon cinnamon. Not sure if I just go with staying in my drugs, or if Hawthorne would do any harm, or ease off the dose to replace with Hawthorn. I am monitored on small machine at home, seem to be OK.

[@Jacobs_Travail]

Can you lay flat? Do you get symptoms when you do?

[@buster9106]

@@Jacobs_Travail I can lie flat and I don't get more symptoms.

[@augustaporter3735]

Thank You you are so good at explaining about the heart in such a simple matter. You make it easy to understand.

[@BarbaraEllis-si2rs]

Thank you Dr Gupta for your info on heart failure. It is good to be informed of new develpments.Happy Christmas to you.

[@weldon7828]

Great video, very informative. But could you address those of us who have a low EF but no hospitalization, no swelling, and able to walk 2 or more miles without being out of breath. I’ve been taking medication for seven years but reduced over the past year.

[@LemonLimes99]

it just means you are well compensated. how are you doing now?

[@franceshemery5095]

Thank you fir more up to date info.wishing you a good wknd also.it really is helpful to see through the obvious confusions and opinions.thank you.

[@susibul5320]

So would magnesium glycinate relax the heart enough to improve the ejection rate?

[@christinelaker]

My husband has just had an aortic valve replacement. He also needs to have dental work. Can you do a video on the implications of dental work on patients with artificial heart valves.

[@nellycastillo633]

Good evening. How I rely on your video re dizziness, low blood pressure 113/69?, I'm turning 61 yrs. old. It's good to hear your explanations and recommendations. Take care ❤

[@dianelipson5420]

Is there any way to bring back the condition of the heart with exercise if the ejection fraction is preserved?

[@krishisonar8931]

Love uuu sir big fan I am also an heart patients and i have a leaky heart valve and now i am 19 I love to see your video

[@vickielewis3848]

Highly informative and thought provoking. Thank you for these ongoing videos. Subscribed and listening. Greetings👋 from Sunnyvale California USA .👱‍♀️🐈🐈🐈‍⬛💕💜🇺🇲

[@jeangriggs201]

Thank you so much for your good information and hard work.

[@machomalli]

Dear Dr. Gupta, I've had heart attack six months ago and my Left Ventricular ejection fraction (LVEF )reduced from 60%( normal) to 45%. I'm wondering can I restore my ejection fraction back to normal (60%) by life style changes such as diet and exercise without taking medicines. Awaiting your reply.

[@Mary-b9b]

I got a stent inserted yesterday.l had been having Angina pain for2 years but wasn't been taking seriously.Two weeks ago l could only walk about 6 metres and the Angina pain would start.On Tuesday chest pain woke me up and l got appointment with GP early next morning snd she got me admitted to hospital.My Artery was 95 % blocked.Glad she spotted how serious it was .

[@jacobgnanapragasam929]

Dr. Thank you for this video on such an important topic.

[@dodgycat476]

Hello Dr Gupta, I have been diagnosed with severe AS with preserved ejection fraction, no history of heart issues, a murmur was detected randomly during a hospital visit for rheumatology. Now being told valve surgery is the only option. Listening to your session has been very helpful as I understand some of what is happening with my heart function, so thank you.

[@mballer]

Have you done any video on methylene blue? So many things I wish I had known a decade before. Do you cook or have any recipes for healthy hearts? What about exercise routines? Have any suggestions for a daily routine? Should everyone buy a dog to have an excuse to keep the dog healthy by taking it for a walk? Are there any worthwhile wrist band heart rate monitor blood pressure calculators?

[@gaylecheung3087]

Yesterday I felt like I was going to die, I was carrying my groceries home, knew I shouldn’t have. Carrying 10ish lbs on my left shoulder my 2, 15ish per bags of chicken, 3 flights of stairs and singing opera home… took me 20 minutes to cool down and catch my wind, yes chest kind of hurt, angina… should I call ambulance, no… finally I cooled down… had to make a dinner… burping like an idiot… I had my heart attack back in 2019, 70% blockage RCA stent… thank you for sharing ♥️🇨🇦🌏🎄

[@kimberlyarjune6854]

good morning sir I love watching your videos thank you for your time I'm watching from guyana

[@wendydee3007]

Would this medication be prescribed for someone like me with permanent fast AFib and heart failure? Thank you.

[@freekfaro5606]

Dr Gupta I'd appreciate your advice, even if it is from a distance. I am 70 years old, 1.82, 80 kgs, normal blood pressure. I was diagnosed with LVH during a regular check up for insurance purposes. I have a background in bicycle racing from 1980 to 1995. I had VO2max from 60 to 75. Rest heart rate in the early 80s 40 to 45. For the last couple of years i feel chest pains when exercising, 9 months ago the LVH was pointed out to me during that check up. A simple question, what to do? I'm a bit worried. Thanks in advance, and Happy New Year.

[@sharonhill349]

Thank you so much for your videos Dr Gupta 🙏 I would be interested to hear your views on Franks crease, a crease on the earlobe that could indicate heart disease, there is not much info about but apparently it’s a very good indicator for heart attack , many thanks and God bless you for all you do 🙏

[@shanes.9089]

Great video Dr Gupta ! Your videos are always so appreciated! I as well as many commenters here would love a follow up video about how its going now data wise with these drugs like Jardiance and Entresto . Cardiologists in the States seem to want to put patients on a cocktail of the two together to improve EF . They want me to and my EF is 50 so not sure if it is a good idea with the known side effects and with what I am on already.

[@lowhombre]

Hello Dr. What do you think of red wine consumption (in moderation) and how it affects the heart and body?

[@richt6353]

Thank You for this Info!!

[@stevefisher4394]

Hey Dr Sanjay, how about talking about aneurisms is a future video?

[@marlineemmal6458]

And dilation of sinuses of Valsalva.

[@BruceNewhouse]

Excellent video even among your standard excellent videos. Very informative, interesting and even exciting. Thank you.

[@paulfasse8032]

Dr. Gupta you are a very kind gifted gentleman sharing vital information in a way we can all understand. Thank you sir and may God be with us all. ❤️

[@angela1981]

Hi do you have any videos on Pre-eclampsia? I searched and couldn't find any by you

[@moisesibrahim4078]

May the Lord bless you , I've been watching you since pandemic & I got covid last 2021,

[@lisanielsenviolin6475]

Thank you for the information. I am trying to learn as much as I can to help my husband and his doctors.

[@getzknowledge]

Good morning DR HNY, I was diagnose with mid range HF and just recently started on ENTRESTO. Been athletic my whole life never had Symptomen was in hospital due to elevated liver enzymes and that’s when they ran a bunch of test including eco gram and saw my condition. How do you feel about ENTRESTO thank you for your time😊

[@sapphiresoul9547]

Thank you for your time. Could you please do a video on Entresto. Partner is triple heart bypass of 24 years ago. Hospitalised after Covid vaccine and reduced EF to 20-25%. Came out in Ramipril and transferred to Entresto, hailed as a miracle support and possibility of increasing EF. No such result has been paired with Dapagliflozin again no improvement. His tiredness is becoming more. His consultant has said that as his EF has not improved in this time it is unlikely to. I am also researching CoQ10 but it’s taking time as my degree isn’t in Medicine. But would be great to hear more in the Entresto please.

[@shanes.9089]

Has your partners EF improved on Entresto or Jardiance? How is he doing these days?

[@sapphiresoul9547]

@@shanes.9089 Yes his EF went up to 40 after being in low 20’s. He was hoping this would mean they could lower his meds a bit but there has been no suggestion of this. It certainly does seem to be as good a drug as the studies suggest. They also put him in Dapagliflozin. Which is a diabetic medication that they almost accidentally found helped with heart failure. He has also had an ICD fitted. He wasn’t happy about it. He’s not had a problem and it’s not gone off. But it did recently alert the team that he had a build up of fluid. All very clever. I hope that helps.

[@christinelaker]

discovered you just day in 2022. So much wonderful information for the lay-person. Really love your videos. Yorkshire girl now in Australia.

[@sparkys2711]

Thank you Dr Gupta for all you do🙏 Question: I live with a lot of pain. My blood pressure is up and down constantly. Can you tell me, can pain cause high blood pressure? Also, I have too many side effects to take meds and wonder if I really need?Thank you very much❤

[@mballer]

Pain can do that but nobody knows about your pain. Even just thinking about things can raise blood pressure. What kind of pain do you have?

[@brooksrogers1975]

Will be interesting to see if 102 ¾ year old mother will be a candidate with 60-65% EF, no periph edema, no fluid in lungs heard. Concerned about UTI and fungi though. UTI for her is debilitating. Was listening to you a long while back b/f Mom's diagnosis last spring. Very grateful that your many insightful and clear explanations helped us both understand the diagnosis and treatment.

[@mathish1477]

I know the v a x caused my pericarditis because I was on an island working in the field as a biologist (an island without the virus), and only got symptoms after getting the jab. My question is how do I get healthy now?

[@lisacaroline76]

Love your videos!

[@playsaboutmycat]

Have you or will you cover how kidney disease can effect the heart? Particularly, if it can cause LVH. Also, if poisoning causes the CKD, what the time frame would be for the thickening? Thank you!

[@dhandaisaminath3403]

Yes please dr. Thank u.

[@ronbonora7872]

can you please do a video on Frank's Sign (diagonal earlobe crease) is this actually a marker for future heart attacks.

[@user-fr9wg9ft3p]

This is very interesting. I go to echo screenings every five years since I was a kid. In the 90s it was only ECGs. In the 2000s I started getting remitted to echos instead and the cardiologist would tell me it was a really good method. Mid 2000 I first came into contact with BNP measurements as a screening method. And now we're at a place where people are saying echo is a crude method. I don't think failure with preserved EF was even recognized back then. Considering the effect of SGL-2 inhibitors in reducing risk in diabetes, are there any studies on using these as a preventative in people with high risk for heart failure before they've developed failure e.g. people with myocardial damage? I really appreciate these calming and factual videos because everything about heart disease is so alarming and fills me with panic, not to mention the horrors you find when googling.

[@erikdog2430]

Will watch later...sounds spectacular...Emporer??.. saw that on Tony!...I agree

[@joycewilcox2549]

I use carb restriction and fasting to manage my T2D so I would be concerned about hypoglycemia with an SGLT2 inhibitor. Has this been studied?

[@DF-ju4cw]

In which of the shows are the injections discussed? Thank you ❤

[@toni4729]

Very interesting. Thank you very much.

[@augustaporter3735]

I forgot to make a comment. I’m 72 y/o grandfather died age 45 with cardiomyopathy. In 2020 was in the hospital and had cardiopulmonary arrest. I have been having a heart rate at night in the 40’s cardiologist says he is not worried about it and I should not be concerned. I also have gone the other way to SVT. They say tachy /Brady syndrome. I have had 5 heart Caths for what ever reason. I’m always find no blockage but have aortic plaque. I have been having periods of air hunger and a drop of my oxygen level from 96% to 84% not long it changes back. Only to repeat over and over when I am resting. Makes me anxious. Then my heart rate goes up. Lots of leg spasms and jerking and pitting edema in my legs. With much pain. When feeling breathless . I have fatigue a lot and have to Rest. Last ef was 60%. Around 5 month ago. I asked to see the doctor again for the edema and breathing problem but have to wait 6 more days for appointment.

[@ronsmith4836]

What do you make of British Heart Foundation hiding information Dr?

[@ranjanarawat8285]

Dr Gupta , I have been watching your videos regularly they are very informative.Could you do a video on Hypertrophic Obstructive Cardio Myopathy and the research and treatment for it. Thank you .

[@davidg2573]

Dr. Gupta i really enjoy watching your videos. I want to know are ectopics an hour or two after exercise dangerous?

[@bignorthernbear]

Thanks for this !

[@nodice8312]

❤always informative ...thank you for doing good

[@joprincevi2702]

Good day good doctor, i just want to ask that is it ok to do cardio exercise if have PVCS?

[@steveone9375]

thanks again for a very informative talk

[@kathyh857]

Amazing video such good news!

[@omaramusa]

I would be very curious to see SGLT-2 vs optimally managed diuretics. Just adding a drug with a diuretic effect and noting a reduction in hospitalizations (where patients are given extra diuretics) doesn't necessarily prove a unique beneficial class effect of the medication on heart function.

[@michaelplunkett5124]

Yeah, a lot of doctors agree. But, do you think you’ll ever see a study? Extremely simple to to but no way Big Pharma will allow it. They’d much rather pay speakers to push these drugs.

[@motomono]

Hello. Thank you for great videos. I have a question- what is your opinion about creatine monohydrate and afíb? Everybody around say taking it can be beneficial for the heart. What do you think about it?

[@saundragray1945]

Thank you Dr. Gupta.

[@grooviechickie]

I have a question: What do you advise for wild type cardiac amyloidosis? ❤ Thank you.

[@dhandaisaminath3403]

Thank God fir you sir. Dr. Hope ur dad is back to perfect health.

[@tabascocat5102]

Is diastole/relaxation passive? Or does that require energy too?

[@mollylindell6009]

Thank you!

[@michaeljack6517]

I’m confused. How effective has SGLT2 been for HFrEF?

[@JimWeaverFeb11]

Thank you so much.

[@JesusSanchez-jl1ff]

Great talk! I do have a question about ejection fraction (EF). I got my heart checked earlier this year and the cardiologist said I was fine, although my EF was about 57% Now, even though I have palpitations due to anxiety and gastric problems, I am otherwise a healthy 52 year old male. I exercise regularly, and I control my weight. I've been stair climbing every day for the past 3 years, and I feel great. Is my low EF a bad sign?

[@ianthecosmonaut]

Your EF is actually perfectly normal!

[@Wales-forever]

57% is good

[@nazillamehralian4161]

Your ef is perfectly fine maybe you should google or ask your doctor. It has the guidelines in there

[@sharons.4590]

People do not understand that normal ejection fraction is 60% not 100%¡

[@Jacobs_Travail]

Are you a troll?

[@dianefaust6218]

Would you recomend medication? Total blockage.

[@abhisheksingh-mw7os]

Dr Sir pranam 🙏❤️ from india.

[@jankorthorst89]

I have a question thats off topic. Ca you with a ct scan and/or an echo of the heart see scar tissue in the heart?

[@sandy1234853]

hello DR Gupta would you be willing to make a video on brugada syndrom? it would be extremely helpful

[@SteveWoods-hq4nw]

Two years ago I was laid up with some bug for six weeks, fatigue, tiredness wiped out. Then after six weeks I had a chest infection for two weeks. After the chest infection my heart rate when standing went up to 180 bpm. This went on for a week then I woke with a pain in my chest and stomach and my heart rate dropped to 44 bpm, with escape and miss beats. I went to the Hospital they said this is normal. No way, your heart do not change like that suddenly. With the history of illness for the last Eight weeks. Some thing has gone wrong with my heart. But they will not listen. At the time I was doing keto diet, which lately have proved heart scaring. I firmly believe my heart problems is from this keto or I have had a virus hit my Heart. I'm 57 and before this I never had any heart problems. Now I'm fatigued, shortness of breath and sleeping a lot.

[@MiteshDamania]

Did u get the covid shots?

[@marlineemmal6458]

An American cardiologist whose name escapes me said, "There are two kinds of cardiologists -who are vegan and those who haven't read the data." Go vegan and supplement B 12 sublingually. Keep advocating for yourself until someone believes you and helps you.