E very year, thousands of devotees and trekkers undertake the ascent of the Velliangiri Hills in Coimbatore, Tamil Nadu - a seven-peak range rising to approximately 1,840 metres (6,000 feet) above sea level. The trek spans roughly 6 kilometres of steep, rocky terrain with no formal steps or safety railings along significant stretches of the route. While the spiritual significance of this journey is widely acknowledged, its physiological demands remain largely underestimated. The consequences of this underestimation are documented and recurring. Reports indicate that seven pilgrims died during the 2024 trekking season alone, with breathlessness, sudden cardiac events, and exertion-related collapses cited as primary causes. Forest authorities now formally prohibit individuals with hypertension, diabetes, asthma, or known cardiac conditions from attempting the climb - a restriction that underscores what medical research has consistently established: high-altitude exertion places signifi...

  C oronary artery disease remains the leading cause of mortality worldwide, accounting for approximately 17.9 million deaths annually according to the World Health Organization. In India alone, cardiovascular diseases contribute to nearly 28% of all deaths, with a progressively younger age of onset. Against this backdrop, percutaneous coronary intervention with stenting has become one of the most frequently performed cardiac procedures globally. Yet a growing body of clinical evidence raises a critical question: does mechanical revascularization through stenting address the underlying vascular pathology, or does it simply defer it? The Limits of Stent-Based Revascularization   A coronary stent is a metallic mesh scaffold deployed within a narrowed or blocked artery to restore luminal patency. In acute presentations such as ST-elevation myocardial infarction (STEMI), stenting is unequivocally life-saving. However, its role in stable coronary artery disease is considerabl...

I ndia accounts for approximately one-fifth of all global cardiovascular disease (CVD)-related deaths. A 2024 systematic review and meta-analysis places the pooled prevalence of CVD among Indian adults at 11%, with urban populations bearing a higher burden at 12% compared to 6% in rural settings. Coronary artery disease (CAD) prevalence in India's urban population has risen from 1-2% in the 1960s to approximately 10-12% in recent years. CVDs strike Indians a decade earlier than their western counterparts. Hospital admission rates for CAD complications are reportedly 5-10 times higher among those under 40 years of age. In 2016, cardiovascular diseases contributed to 28.1% of all deaths in India, a figure that more than doubled since 1990. Within this context, managing heart blockages remains a pressing clinical challenge. While bypass surgery and angioplasty dominate conventional treatment, a scientifically validated, non-invasive modality has long existed: Enhanced External...

  C oronary stenting is one of the most widely performed cardiac procedures in the world, restoring arterial blood flow rapidly and effectively. Yet a clinically significant proportion of patients who undergo stent placement return — months or years later with recurring symptoms. The question is not marginal: a 2023 meta-analysis in Reviews in Cardiovascular Medicine identified a pooled in-stent restenosis (ISR) rate of approximately 13% for drug-eluting stents, with higher rates in complex anatomical or high-risk metabolic presentations. Understanding why heart blockage after stent placement recurs is essential for any patient managing long-term coronary artery disease. What a Stent Treats — and What It Does Not A stent addresses a localised anatomical obstruction: it mechanically expands a narrowed coronary lumen and, in the case of drug-eluting devices, locally suppresses the cellular proliferation that drives early re-narrowing. This is its precise and limited mandate. ...