Heart diseases are some of the leading causes of morbidity and mortality globally, and in Sri Lanka. While heart attacks have traditionally been considered ‘ elderly diseases’, usually common in people over 65 years of age, today, there is a disturbing shift in the age of the victims trapped in their relentless grip.
Recent statistics have pointed to a surge in younger patients admitted to hospitals with symptoms of heart attacks. Many of them are still in the prime of their lives and often, sole breadwinners of their families. More worrying is the sudden spike in very young patients in their early twenties now being admitted to hospitals and warded with positive signs of heart disease, some requiring surgery and even heart replacement.
Health officials believe that most heart conditions are directly linked to several other factors, all of which fall into the category of Non Communicable Diseases ( NCDs) which are on an alarming new high at present, even overtaking communicable diseases . Diseases such as, diabetes, hypertension, kidney diseases, are said to be closely linked to heart attacks, strokes, obesity.
Obesity among children is increasingly raising fears of the onset of early NCDs including heart diseases.
Health officials are now warning parents that keeping one’s weight down, refraining from eating processed, fatty oily foods high in starch, sugar, and carbohydrates, as well as, salty foods is the key to prevent their children from developing early diabetes and hypertension leading to heart diseases.
To this end, the Health Ministry is currently vigorously promoting people to exercise more, outside their homes, and minimize the long hours they spend in sedentary work or recreations such as, watching television, playing computer games, reading newspapers and books. ‘Dance, skip, play outdoor games, and keep your bodies active. Eat healthy food and make healthy lifestyle choices”, is the collective message they have for the public.
Treating patients with heart attacks is costly. Since over 90 percent are preventable, the focus is now on preventing them, thus reducing the burden of the disease and its adverse effects on the country’s economy as a whole.
The Sunday Observer spoke to General Physician, attached to the Ministry of Health, Dr Ramya Premaratne to find out how heart attacks occur, how they can be detected ahead, treatment, procedures available in Sri Lanka, and most importantly how they can be prevented.
Q. What happens to your body during a heart attack?
A. During a heart attack, the heart muscles lose blood supply and as a result get damaged. The blood is usually cut off when blood vessels [arteries] supplying the heart muscles are blocked by blood clots.
Q. What kind of symptoms would the patient feel at that time?
A. When this happens the person experiences severe pain and discomfort in the chest.
Q. Who are those most at risk of getting a heart attack age wise and gender wise?
A. The risk of a heart attack increases when a man is over 45 and a woman is over the 55 age range.
However, it is more common in adolescents and young adults than most people realize – it can affect anyone, at any age.
The younger population is often unaware that they may be at risk and may fail to take the appropriate actions that could save their lives. Educating parents, adolescents, and young adults about the different risk factors is the best way to help prevent death and reduce problems associated with cardiac disease.
In particular, childhood obesity has quickly become a global epidemic where 1 in 10 children are estimated to be overweight. Obesity can lead to precursors for Cardio Vascular Disease such as, dyslipidemia (high cholesterol), hypertension (high blood pressure), type-2 diabetes.
If these conditions are left unchecked, premature cardiovascular disease can occur, leading to significant health problems in young adults. Additionally, cardiac disease in the young can also be caused by undiagnosed or untreated congenital heart defects and abnormalities.
Q. What other risk factors could contribute to a heart attack?
A. Smoking and overweight are big factors, particularly, in the at-risk age range.
Other factors include:
High blood cholesterol or triglyceride levels
These increase the chance of blood clots in the arteries. A high level of low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) is most likely to narrow arteries.
A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack.
However, a high level of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) lowers your risk of heart attack.
Your total goal should be less than 200 mg/dl. Your HDL, the good cholesterol, should be higher than 40 mg/dl if you’re a man and higher than 50 mg/dl if you’re a woman (and the higher the better). Your LDL, the bad cholesterol, should be less than 100 mg/dl.
Unhealthy eating habits such as, consuming food that contain large quantities of saturated fats may induce heart attacks.
Diabetes-
Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes — not producing enough insulin or not responding to insulin properly — causes your body’s blood sugar levels to rise. Diabetes, especially, uncontrolled, increases your risk of a heart attack.
Q. Can we inherit genes from close relatives that put us more at risk of heart disease than others?
A. Yes, Genetics plays an important role. You can inherit a higher risk of heart attack when you have a family history of Heart Attacks.
Hypertension - also known as high blood pressure, also puts you at risk.
Q. What about obesity which is now spreading fast among our population with more than half the population currently being over the ideal weight according to the Body Mass Index (BMI)?
A. Yes Obesity - or being significantly overweight, is definitely an issue.
Obesity is a BMI of 27.5 or higher
Obesity is strongly correlated with body fat levels, as measured by the most accurate methods.
Hundreds of studies show that a high BMI predicts higher risk of chronic disease and early death.
Body mass index (BMI) is the ratio of weight to height, calculated as weight (kg)/height (m2).
Normal weight is a BMI between 18.5 and 22.9;
overweight is a BMI between 23.0 and 27.4;
obesity is a BMI of 27.5 or higher.
Q. Previous heart attacks – can this be a contributory cause?
A. Yes.
Almost 20 percent of patients who’ve experienced a heart attack will have a second heart attack within the year, but whether follow-up heart attacks merely reflect worsening atherosclerotic disease, [in which the accumulation of fatty material such as, cholesterol thicken artery walls] or whether heart attacks themselves instigate further heart problems has been unclear.
Research suggests that stress during the initial heart attack stimulates production of inflammatory cells that destabilize atherosclerotic plaques, increasing chances that existing plaques will rupture and cause more heart attacks.
Researchers say this post-heart attack inflammatory process could provide a new therapeutic target for preventing future heart attacks.
Q. Tobacco Smoking has often been cited as leading to heart attacks. How?
A. Smokers are at much higher risk than non-smokers. To prevent heart disease, smoking should be avoided.
Smoking may cause heart disease in a variety of ways. Smoking of tobacco products impairs the lungs, which can lead to reduced blood flow into the heart, and cause an inability to remain physically active.
Tobacco products containing nicotine have also been shown to increase blood pressure, which is a risk factor for heart disease.
In some patients, smoking may also lower HDL or “good” cholesterol, another risk factor.
Cigarette smoke damages the heart and blood cells. It can also cause:
Aneurysms – an expanded and weakened area in the artery. Once it ruptures it can result in internal bleeding, stroke and death.
Atherosclerosis: – a buildup of fats and other substances in arteries. The buildup can block the artery or cause a rupture resulting in death.
Coronary heart disease: – the damage to, and weakening of the heart’s major arteries.
Elevated blood pressure: – which can lead to heart disease and stroke.
Q. Work stress has been cited as another cause. Your comments?
A. Workers with stressful jobs are very vulnerable to stress related heart attacks.
Q. Many of us lead sedentary lives. Please explain why this puts us at risk of heart diseases?
A. Physical inactivity- is a factor in heart attack risk, and the more active people are, the lower their risk of having a heart attack.
Inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.
Q. How are the symptoms presented?
A. A feeling of pressure, tightness, pain, squeezing, or aching in the chest or arms that spreads to the neck, jaw, or back can be a sign that a person is having a heart attack.
The following are other possible features of a heart attack occurring:
Difficulty in breathing.
feeling clammy and sweaty
coughing
nausea
vomiting
dizziness
face seeming pale in colour
a feeling of fear
restlessness
Q. What should you do when someone develops these symptoms?
A.Get the person admitted to the nearest hospital immediately.
Q. Let’s talk about treatment.What are the treatments for heart attack?
A. These days, most heart attacks can be dealt with effectively.
However, it is crucial to remember that a person’s survival depends largely on how quickly they reach the hospital.
Sometimes, a person who is having a heart attack will stop breathing. In this case, cardiac massage [manual chest compressions] and artificial respiration, should be started immediately.
Diagnosis of heart attack is usually throughECG (or electrocardiograph), cardiac enzyme tests (Troponin).
Q. Treatments following a heart attack?
A. Most people will need several kinds of medications or treatments after a heart attack. The aim of these measures is to prevent future heart attacks occurring.
They must be taken strictly adhering to the advice of the prescribing doctor. Recovering from a heart attack can be a gradual process. It depends on the severity of the heart attack and other factors, such as a person’s age.
There are several life-saving treatments that can open the blocked artery that is causing the heart attack. The blocked artery can be opened by injecting clot-dissolving drugs into a vein (you may hear this process referred to as “fibrinolysis”) and through a procedure called “angioplasty.”
Angioplasty is performed in a special unit of the hospital called a cardiac catheterization laboratory (“cath lab”).
Angioplasty may involve the placement of a small wire device called a “stent,” and the procedure is sometimes called “percutaneous coronary intervention,” or PCI. A stent is shaped somewhat like the spring of a ballpoint pen and may be inserted into the artery to help it remain open after the clot is removed.
Since this procedure is somewhat costly the government has recently started to give stents freeof charge to enable the general public to avail of this surgical procedure.
Medications are often used to thin the blood and allow for better passage through the arteries in those who have blockages.
Other medications help regulate heart rhythms, lower blood pressure, or lower cholesterol. Those with severe cases may require surgery to repair diseased or blocked areas of the heart, or in some rare cases a heart transplant may be necessary.
Those with heart disease, or who are at high risk of heart disease, should follow dietary and lifestyle guidelines set up by their doctors.
Q. What does this involve?
A. A person’s recovery may involve:
Resuming physical activity: it is vital that a recovering heart attack patient stays active. However, a specialist should design any exercise program for them.
Returning to work: the appropriate time for someone to go back to work depends on various factors, including the severity of the heart attack and the type of job they do. It is vital not to rush back to work.
A period of depression: many people who have had a heart attack experience depression . Those who feel depressed or anxious should consult their doctors.
Q. Can a person drive after a heart attack?
A. Most people who have had a heart attack without complications can resume driving within a reasonable time depending on the severity of the disease and the advice of the physician.
Q. Complications after a heart attack?
A. There are two types of complications that can happen following a heart attack. The first occurs pretty much straightaway and the second happens later.
Q. What are the immediate complications?
A. Immediate complications are when:
The heart beats irregularly, either too fast or too slowly.
A person’s blood pressure drops suddenly and the heart cannot supply enough blood for the body to work adequately.
Levels of oxygen in the blood become too low.
Fluid accumulates in and around the lungs.
The deep veins of the legs and pelvis develop blood clots that either block or interrupt the flow of blood in the vein.
The heart attack damages the wall of the heart, meaning an increased risk of a heart wall rupture.
Q. What about complications that can occur later?
A. Scar tissue builds up on the damaged heart wall, leading to blood clots, low blood pressure, and abnormal heart rhythms.
Not enough oxygen reaches the heart, causing chest pain.
The heart can only beat very weakly, leaving a person feeling exhausted and breathless.
Fluid accumulates in the ankles and legs, causing them to swell.
The lining of the heart becomes inflamed, causing serious chest pain.
It is important that a doctor monitors a person for several months after they have had a heart attack to check for any of these complications that may occur.
Q. Lastly, the most important question: Prevention of Heart attack. How can they be prevented?
A. The best way of preventing a heart attack is to have a healthy lifestyle. Measures for healthy living include the following:
not smoking
eating a balanced, healthful diet,
- avoid butter, cheese, oily foods, fast foods,
- take small frequent meals
- eat fruits, vegetables, grains
- eat lean meats like chicken/ fish
regular exercise – 45 minutes brisk walk at least 5 times /week
sound sleep 6-8 hours
keeping diabetes under control
keeping alcohol intake down
maintaining blood cholesterol at optimum levels
keeping blood pressure at a safe level- 130/80
maintaining a healthy body weight
avoiding stress where possible
What about the Future?
Many, many people recover fully from their heart attacks and go on to lead long, healthier lives. You can help the person you are caring for do that by making sure that he or she follows the ABCs of prevention:
Avoid tobacco. Smoking after a heart attack doubles your chances of having a second one.
Become more active. Regular exercise or activity at a cardiac rehabilitation program can make a significant difference.
Physical activity eases stress and depression, helps control weight, and can lower blood pressure and cholesterol levels.
Choose good nutrition. Healthy eating will help control weight, lower blood pressure and cholesterol, and help the body heal faster.
This is good advice for everyone in the family - not just the heart attack survivor.