September 29 will see thousands of activities and events around the world to spread the message of how we could combat premature mortality caused by Cardio Vascular Disease (CVD), the world’s number one killer, including Sri Lanka. Heart disease, especially, Ischemic heart disease has maintained its position as the number one cause of hospital admission for over a long period and is unlikely to see a drop in the near future. It is a matter of concern for health officials who say that although mortality rates from CVD have dropped due to various interventions, the long lasting scarring effects of a heart attack remain, robbing the victim of reaping optimum benefits of a healthy life.
Cardiovascular surgeon Karapitiya Hospital, Dr Namal Gamage told the Sunday Observer how CVD could be prevented while emphasising that the trigger factors that cause it in most instances merely require a few lifestyle modifications that cost next to nothing.
Excerpts…
Q. Heart disease is the leading cause for morbidity and mortality in Sri Lanka. Hospital admissions of those with Non Communicable Diseases ( NCDs) bear evidence that the majority of people over 60 years and even much younger being admitted to hospitals, suffer symptoms of heart disease such as shortness of breath, palpitations, etc. Do you agree?
A. Yes. Heart disease, especially, ischemic heart disease has been the number one cause of hospital admission in the non communicable diseases category for several years, although the mortality rate is not that high due to interventions in place.
Q. What are the main causes for the persistently high number of heart patients in Sri Lanka?
A. Uncontrolled high blood sugar or diabetes, uncontrolled high blood pressure, smoking habits, unhealthy food habits, lack of exercise, uncontrolled high blood cholesterol levels, work related stress, environmental pollution and genetic predisposition.
Q. Are there different types of heart diseases?
A. There are two main types, which are congenital or inborn e.g: hole in the heart; and acquired heart diseases which occur later during life, like ischemic heart disease.
Q. What is ischemic heart disease? How does it occur?
A. Ischemic heart disease occurs due to ischemia or inadequate blood supply to the heart muscle which may occur gradually or suddenly.
Blood supply to the heart muscle is through small blood vessels or arteries called coronary arteries 1-2.5mm in diameter, and this blood supply is mandatory and adequate for the proper functioning of the heart muscle which is the energy generating component of the heart which works as the one and only pump to maintain blood circulation for the whole body.
Q. Who are more vulnerable age wise and gender wise – males or females? Why?
A. Males, generally after their teens start getting ischemic heart diseases and it increases with age. Females, due to the hormones in their blood up to menopause are less likely to get ischemic heart diseases compared to their male counterparts. But after menopause they also run the same risk as same age men.
Q. Are the symptoms for both men and women the same?
A. Signs and symptoms of ischemic heart disease are same in males and females.
Q. Do hormonal imbalances count in at risk women?
A. Normally females are somewhat protected before their menopause but if premenopausal women for some reason or other are treated for a disease with high doses of progesterone, they could become vulnerable to ischemic heart disease.
Q. New studies have revealed that there is a link between the causes of cardiac diseases and stroke. How would you identify whether it’s a stroke or a heart attack?
A. Causes for ischemic heart disease and stroke or paralysis are very similar.
Q. Are persons with pre-disposed conditions like diabetes, hypertension, high blood cholesterol more vulnerable to heart disease?
A. Yes, but when they are properly controlled with medication, diet and lifestyle modification the risk could be minimized.
Q. Obese women – are they more at risk of heart attacks?
A. Obesity poses a high risk in postmenopausal women. Obesity is directly linked with diabetes, high blood cholesterol and high blood pressure.
Q. Can you inherit heart disease if your family has a history of heart problems?
A. Genetic predisposition is an important causative factor for ischemic heart disease. If one parent is affected with ischemic heart disease the offspring is more vulnerable to the same, compared to the offspring of unaffected parents. If both parents are affected the risk is several times higher. Some of the congenital or inborn heart disease like hole in the heart (eg; atrial septal defect - ASD) can go in families.
Q. Can work related stress increase the risk of heart attacks?
A. Work related stress harms your body from within by increasing stress hormones like adrenaline, noradrenaline, glucogen etc. Persistently elevated, these hormones alter your body chemistry which leads to spasm or narrowing of the diameter of blood vessels and precipitation of cholesterol deposits inside the interior layers of those small blood vessels, both leading to narrowing of coronary arteries. Stress is also linked to bad eating habits, lack of exercise and lack of rest and sleep, smoking and alcohol indulgence - all precursors of ischemic heart diseases.
Q. Eating takeaways and junk meals – do they lay the foundation for early heart disease?
A. Yes, especially oily foods taken from outside are dangerous as the oils are used repeatedly for frying and high temperature generated inside the oil produce very harmful fatty acids. Therefore, these fast foods are several times harmful when they a purchased from outside sources.
Q. Once you get a heart attack can it recur? If so how soon?
A. Yes. Persons with a past history of heart attack are more liable to get another heart attack. If a person has had two sequential heart attacks he is several times more liable to get the third one and the time duration shrinks between the attacks.
Q. Is heart disease preventable?
A. Heart disease is preventable. Except for the genetic factor, all the other causes can be modified in a safe way to prevent heart disease e.g. proper treatment of high blood sugar and pressure, healthy food habits, proper and regular aerobic exercises, a stress free lifestyle and avoiding active or passive smoking.
Q. Treatment?
A. Treatment is individual specific but according to guidelines only, which are more or less similar. Now the trend is, as soon as you get a heart attack an X ray image of your coronary blood vessels will be taken, and steps taken to immediately dilate the narrowed or blocked places and put a sheath hold stent to prevent them closing down again. Unfortunately, this service is not yet widely available in our country.
Q. Can a mild attack be treated at home ?
A. No. A heart attack can rapidly progress . If there is the slightest doubt about any chest pain admission to the nearest hospital is a must since no chest pain can be differentiated from a heart attack at home.
Q. Can one resume a normal life after a heart attack that involves bypass surgery?
A. The goal of the Cardiac Care team is that following treatment either medical or surgical, involving bypass surgery, the patient returns to his normal productive life.
Sometimes this may not be possible 100% if the heart is damaged from the previous heart attacks which retards the efficiency of the heart. Early admission and treatment is a must to avoid secondary attacks.
Q. Role of exercise in rehabilitating heart patients?
A. Exercise for patients who undergo bypass surgery or stenting is usually encouraged. But if the heart is damaged due to a severe heart attack it may not be able to cope with exercises at once.
These patients are given limited exercises evaluated by the cardiac care team of cardiologists, nurses, physiotherapist and doctors.
Q. Gaps you like to fill in heart care in Sri Lanka?
A. Tertiary care centres for heart patients are very limited in number in Sri Lanka, while the available centres are not functioning smoothly. Some centres do not function at all.
Hence patients have to travel from one end of the country to another to get their bypass surgery angiogram or their stent done. There are very long waiting lists for these patients to undergo these procedures. A large number of patients in the waiting list die without even getting near their turn.
Q. Dos and Don’ts for heart patients?
A. Always follow your doctor’s advice and discuss your problem with your cardiologist. Strictly adhere to your medication which is generally life long. Irregular and periodical medication is harmful and must be avoided.
Don’t risk your life with unscientific so called native treatment which in my experience do much more harm than good.