In two days, heart specialists will focus their attention on a subject that is now of serious concern – namely, the rise in heart diseases globally and in Sri Lanka.
Consultant Cardiothoracic Surgeon, Karapitiya Teaching Hospital Dr Namal Gamage shares his views with the Sunday Observer on the importance of raising more awareness on heart diseases to minimise risks to this common but preventable disease that causes major health impacts on patients in Sri Lanka.
Excerpts:
Q: World Heart Day will be observed in two days, on September 29. What are the main issues that heart specialists across the globe will focus on that day regarding heart illness?
 Dr Namal Gamage |
A. In a country such as ours tertiary or advanced care for heart illnesses is not widely available free throughout the country. So, the main focus must be on prevention of heart diseases. In addition, doctors caring for heart patients are trying to establish advanced heart care centres throughout the country but economic and man power issues remain a big obstacle.
Q: Sri Lanka has its own unique reasons for the rise in heart disease. What are they?
A. Lifestyle problems such as the lack of exercise, excessive eating of unhealthy foods such as, oily foods, red meat, butter, margarine made out of saturated fat and high consumption of salt, starch or starchy foods, sugar or sweets and inadequate or reluctant intake of fresh vegetables, fruits and cereals. Living in a stressful environment is also very harmful.
Q: Genetic factors – do they also contribute to heart diseases?
A. Yes, genetic factors play a big role. If a person’s first-degree relative has a history of heart disease that person has a 50% risk of developing acquired heart diseases such as, ischemic heart disease and cardiomyopathy which is a disease involving the heart muscle or myocardium. In addition, congenital or inborn heart diseases such as, hole in the heart also are more prone to pass on to offspring.
Q: Non Communicable Diseases ( NCDs) – is there a link to heart disease?
A. Most heart diseases are non-communicable diseases except for a few infective diseases caused by germs, such as, various viruses and bacteria (like TB). The majority of non-communicable diseases (NCDs) have very big genetic or familial tendency.
Non -communicable diseases in general are caused by the patient’s lifestyle, dietary habits, surrounding environment and are secondary to other non-communicable preexisting diseases like high blood pressure, diabetes mellitus, elevated blood cholesterol levels and other uncommon metabolic syndromes in the body.
Genetical predisposition or family background play a special role so that heart diseases are common among people who have non optimally controlled high blood pressure, diabetes mellitus and elevated blood cholesterol levels.
Q: Commonest heart diseases one sees in Sri Lanka today?
A. There are two types of heart diseases, Congenital or inborn heart disease where the baby is born with some heart disease and Acquiredheart diseases which the person acquires late in his life due to the factors mentioned above. Of the congenital heart diseases, hole in the interventricular septum or VSD is common followed by hole in the interatrial septum or ASD.
Of the acquired heart diseases ischemic heart diseases or coronary heart disease is far more common not only in Sri Lanka but the world over. They are followed by acquired valvular heart diseases or diseases of heart valves which are situated inside the heart.
Q: Are they different from the cardiovascular disease (CVDs) you saw a decade ago?
A. Yes, ischemic or coronary heart disease is on the rise and is the biggest workload of contemporary cardiologists and cardiac surgeons. Valvular heart diseases a decade or two ago were mostly caused by a childhood infective disease called rheumatic fever leading to rheumatic carditis. Rheumatic fever is rare now and therefore the valvular heart diseases are less in number these days.
Congenital or inborn heart diseases are also less now due to the recognition of causative factors and health education of the population to avoid these things.
For example, causative factors for these are, rubella virus infection during early months of pregnancy, using harmful drugs during pregnancy, consanguinity or marriage between close blood relatives, smoking actively or passively and elderly onset of pregnancy beyond the age of 35 years for the mother.
Q: Those most at risk of getting CVDs age wise?
A. Acquired heart diseases increase with maturing age unless there is a familial tendency for coronary heart disease. They start appearing in the 5th and 6th decades of life.
Degenerative heart valve diseases occur a little late in life. Congenital heart diseases are there from birth and every 5 out of 1,000 live births have this problem.
Q:Gender wise is it true that women, especially, in this part of the world are more vulnerable to heart disease. Why?
A. Women are less prone to coronary heart diseases before menopause due to the protective activity of their hormones like estragon but after menopause they also run the same risk as their male counterparts.
Q: Recent hospital statistics in Sri Lanka have shown that younger persons, some in the early forties and even thirties are now being warded for heart attacks. What is the reason?
A. Coronary heart diseases in genetically predisposed people start very early in their life, that is, in late teens itself and obstruction of coronary artery gradually increases then onwards. To become symptomatic the artery lumen should be about 70% obstructed.
Other factors like sedentary lifestyle, bad food habits or stress can aggravate and expedite the process and significant blockade of coronaries causing symptoms could occur in much younger age.
Q: Symptoms of heart disease?
A. Symptoms of heart diseases vary according to the type of the disease. However, symptoms common to all heart diseases are: chest pain, angina which is work related chest pain, shortness of breath and swelling of legs.
For example, in coronary heart disease chest pain and angina are predominant symptoms. In valvular heart diseases shortness of breath could be the predominant symptom, in late congenital or inborn heart diseases a patient can get bluish or cyanosed. So, there is a wide array of symptomatology.
Q: How is heart disease diagnosed?
A. Coronary heart disease is diagnosed both in already affected patients and in high risk, not yet affected patients. An already affected patient’s coronary artery imaging by means of a coronary angiogram or a CT coronary angiogram is better than other diagnostic methods. In high risk people screening tests such as, ECG, exercise ECG are used as they are non-invasive. Valvular and congenital heart diseases are mainly diagnosed by echocardiography tool.
All these world-class equipment and techniques as well as well-trained doctors are available in Sri Lanka. But there are long waiting lists as there is a big mismatch between the demand for these services and their supply.
Q: Treatment- What is the best time to admit a patient with symptoms of heart or stroke to hospital?
A. As soon as possible, within what we call the golden hours. Unfortunately, most remote hospitals do not have cardiac care centres. Patients having their own transport mode should thus be brought to a big hospital with a coronary imaging or angiographic facilities, as soon as possible.
If these facilities are not available at a close by hospital the patient should be admitted to the nearest available hospital promptly.
The difference is the hospitals with cardiac catheter laboratory could immediately take the patient for coronary angiogram and immediately unblock the blocked coronary artery before the patient suffers a full-blown heart attack.
Q: Until help arrives what can be done in the house to ease the symptoms?
A. The only recognised first aid is a soluble aspirin (but not enteric coated ones) and TNT tablets or spray under the tongue. Getting the patient quickly to the nearest hospital is the most important thing.
Q: Are young people more likely to survive a heart attack without much adverse after effects than older persons?
A. Yes, because they have a big systemic reserve in their bodies which enables them to stand a heart attack.
When you grow older your systemic reserve gradually depletes and you may also acquire other concurrent diseases like hypertension, diabetes, bronchial asthma, renal problems, neurological problems or obesity which make one’s body more vulnerable.
Q: What are the most pressing needs for heart patients in the future in Sri Lanka? How do you suggest they could be solved?
A. The tertiary care for cardiac patient is expensive and demanding. The aim should be to make available primary coronary angiographic interventional facility provincially. We must ensure that existing Cardiac surgical centres function fully before considering to increase their number .
Unfortunately, cardiac surgical centres at the Kurunegala and Anuradhapura hospitals do not function at all despite surgeons being appointed for those units for years now and patients from those areas have to come all the way to functioning cardiac surgical units at Karapitiya, Kandy and Colombo where there are very long waiting lists.
A big percentage of these patients die before getting the surgery done while being in the waiting list. This is the horrendous truth.
Q: Your message to the public on Dos and Don’ts to minimise heart risks?
A. Prevention is the most important thing. As coronary heart disease is an acquired heart disease, minimise modifiable risk factors .
Eat less oily, less starchy, home cooked food and avoid fast foods. Do more aerobic exercises. Avoid smoking both active and passive and enjoy your job and family life without stress.
