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Effects of smoking in ASD and its surgery.

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Hello Doctor,
I am a 24 years male with height of 6' 2 '' inch and weight of 75 kg. I had an ASD measuring 4 cm by 3 cm which was left to right shunt. I got it operated through an open heart surgery as balloon closure was not possible due to insufficient superior margin about a month ago. My pulmonary pressure at the time of surgery was 39 mm of Hg. Sir, i have been smoking cigarettes from past 3 years, which i reduced 4 months prior to surgery. I want to ask comprehensive effects of smoking after the closure. Is there any difference in the harmfulness of smoking after the surgery compared to the harm it causes before the surgery when the condition was present? When can i start smoking after the surgery?

Category: Cardiologist

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Category: Cardiologist
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Thank you for your query at
There are no studies to compare smoking in patients of atrial septal defect before and after closure or with normal people. It is very difficult to quit smoking and if you have been successful in doing that i think you should not go back to smoking. Going by logic smoking should accelerate the development of pulmonary arterial hypertension in patients of atrial septal defect before closure. This Acceleration is secondary to the damage suffered by the lung alveoli due to smoking. if some person develop more damage to the alveoli due to smoking he is most likely to develop more pulmonary arterial hypertension than a person who develops less damage to the lung alveoli. Now that your atrial septal defect has been closed the risk of development of pulmonary arterial hypertension is slightly reduced as compared to before closure. however the risk of progression of pulmonary arterial hypertension still persist. it is not absolutely eliminated. Now you have additional risk of development of atrial fibrillation secondary to the surgical scar all your atria and this risk is increased due to smoking. As your age advances you shall be more prone to the development of coronary artery disease hypertension and diabetes due to smoking. this risk would have been present even if the atrial septal defect were not closed. I think you should not go back to smoking
Regards ,
Dr Vivek Mahajan
DM Cardiology

Patient replied :

Sir, I highly appreciate your in-detail answer. I was sure to get a reply to quit smoking as soon as possible but i got a proper reason for that. But I won't be able to quit by saying; I QUIT FROM TODAY. Hope u understand . It would be great if i get information about till when I should not smoke a single cigrette. 2 months 3 months,,,so that I can quit it by will not due to psychological factor of post op. complication? In order words when can i smoke for a short session considering in mind, fibrosis of the scar on atria as it will be fresh still?

Thank you for writing to us again.
Yes I understand. But I advised so because you already have abstained for so long. Regarding restarting the later the better. Scar over the atrium will take 6 weeks to heal and some remodelling will take place over 3 to 6 months.
So 3 months and preferably 6 months would be advisable.
Dr Vivek Mahajan

Patient replied :

Hello Sir, Its good to get direct and educative answers which u can never get during face to face interactions with a doctor. To be very frank, I was very dissapointed with the attitude of Cardiologists and Surgeons during my follow-up as I was never given any reason or any proper advice( just a generalised approach to everyone) even after paying extra bucks for appointments in Fortis here. I want to ask a very personal question here in same context, I have been smoking herb ( THC) from past 2-3 years once a week or more, I want to ask, whether by keeping by diet healthy and exercise routine good ( low-fat milk, green tea, fruits, multi-vits, revital, apple, light multiple diets, walking n jogging), and quiting the cig. also, would I b able to smoke herb again once a week, sometimes its tobacco free too? If not, please suggest the pattern I can follow, like Should i wait for an year, then twice a month or once a month. I am 24 years old with a very enthusiatic work routine and lifestyle which I think goes with a Balance of some goods and some bads. So it will be a miilion dollar help, If you can suggest something positive about this. I know this is Unorthodox, but it is important for me.

Thank you for writing to us again.

The main danger of cannabis is that you may yend to overdose it or may tend to do it frequently.
Some people think cannabis is harmless because it’s a plant, but it isn’t harmless. Cannabis, like tobacco, has lots of chemical 'nasties', which, with long-term or heavy use, can cause lung disease and possibly cancer. The risk is greater because cannabis is often mixed with tobacco and smoked without a filter. It can also make asthma worse, and cause wheezing in people without asthma.Cannabis itself can affect many different systems in the body, including the heart. It increases the heart rate and can affect blood pressure. That is of particular concern. With a scar in the heart increased rate and pressure will cause negative remodelling of the atria and may cause development of atrial fibrillation.
Ideally no medical practitioner would give you a safe limit of abstinence. But since you are nevertheless going to get back to it you should delay it as much as possible. If you think you coild put it off for 1 year then atleast that can be done.
Dr Vivek Mahajan

Patient replied :

Hello again Sir, Yesterday night, it started again. I could feel my heartbeat by feeling and visibly also along with little feeling of breathlessness. I attented a party 2 days ago in which I had alcohol ( 350 ml) and had dance too, but not too energetic medium activity dance with breaks for half an hour or 40 min. Its been almost 4 months to my ASD closure open heart surgery. Please suggest me the possible reason and treatment procedure. Ita panic situation for me. I am working with good activity from past 1 month and going for walks atleast once a day. I am not able to get a quick appointment with my doctore here in fortis. Should I go for Eco cardiography, as I havent get it done after surgery, they just did ecg. Can the patch gets displaced by dance activity? Please respond asap, sir...I am worried. I got tested for alcohol that night, it was 65.4 mg per 100 ml by alcosense. and I didnt drink continuosly neither smoked. Once a week.

Admin Message -
Your consult has been closed. Either you have utilized more than 3 follow-up queries or your consult is now older than 1 month. If you have further queries, I request you to initiate a new consult. You could consult the same Doctor as well, please mention the same in the new consult.
Hope this communication was fruitful. Wish you good health.
Thank you
In-house Physician

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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