The recently concluded World Heart Day (Sept 29) celebrations drive home the message that we still have a long way to go to get a handle on diseases affecting the heart and blood circulation. Two experts give their thoughts on the matter.
Tan Seri Dr Robaayah Zambahari is senior consultant cardiologist and CEO of Institut Jantung Negara. She shares her opinions about the state of heart health in Malaysia.
Heart disease is still the number one killer in Malaysia, and this has been so for the past three decades. Can you explain why the situation has remained unchanged?
Heart disease is the most common cause of death in most countries worldwide, particularly in developing countries. It continues to be the number one killer of Malaysians.
The risk factors for heart disease (atherosclerotic) include increasing age, smoking, elevated cholesterol levels, diabetes mellitus, high blood pressure, obesity, sedentary lifestyle and stress. The majority of these risk factors are related to our lifestyle. We can reduce the prevalence of heart disease by living a healthy lifestyle.
In the Malaysian National Cardiovascular Database NCVD (data contributed by 14 centres and hospitals) 2007 and 2008, amongst patients admitted for acute coronary syndrome, there was a high prevalence of established cardiovascular risk factors – around 33-34% were active smokers, 31-35% had dyslipidaemia, 56-63% had high blood pressure, and 39-40% had diabetes.
Generally, if a narrowing in the blood vessel causes insufficient blood flow, blood flow can be improved either by inserting a stent or by bypass graft surgery. IJN treats 8,000 new heart patients’ annually. Since its inception in 1992, IJN has performed 13,961 closed heart surgeries, 33,850 open heart surgeries, and 114,025 invasive cardiology procedures.
The average age of patients suffering from heart disease is getting younger. This is contributed by multiple risk factors such as high cholesterol, high blood pressure, diabetes, obesity and smoking. These are modifiable risk factors which are not eliminated or controlled.
The Global Registry of Acute Coronary Events (GRACE) has found that the average age of a patient admitted with acute coronary syndrome is 66 years. Compare that to the Malaysian NCVD, where the average age is 59 years old. We’re ahead, which is not a good thing.
Based on data from the Health Ministry, cardiovascular disease accounts for about 25% of all deaths among women. This trend has remained unchanged since 1999. Among women, deaths from cardiovascular disease are almost two and a half times that of deaths due to all cancers combined.
How do you spot an impending heart attack? What are the symptoms that you should look out for? Is there a difference between symptoms experienced by a man and that experienced by a woman?
The predominant symptoms of coronary heart disease (atherosclerotic) are:
*Chest pain or discomfort, usually central or left side of the chest, that may radiate to the jaw or inner left arm. A person usually describes the pain as crushing, pressing and “heavy” in nature.
Dr Robaayah ... Since its inception in 1992, IJN has performed 13,961 closed heart surgeries, 33,850 open heart surgeries, and 114,025 invasive cardiology procedures. It is brought on by exertion and relieved by rest, or medication called glyceryl trinitrate (patients with heart disease usually carry this medication either as a tablet, to be put under the tongue, or in the form of a spray).
A number of people, especially women, diabetics and the elderly, present with atypical symptoms, which may include:
*Difficulty in breathing
*Unexplained sweating, nausea and vomiting, fatigue, and epigastric discomfort.
The symptoms of a heart attack (acute myocardial infarction) is chest pain or discomfort, similar to the above, but tends to be more severe or of longer duration. It can occur at rest or on minimal activity. It is also well known to be associated with sweating, nausea, vomiting, and shortness of breath.
If you are having the symptoms stated above (suspicions of a heart attack):
*Seek immediate medical attention at the nearest hospital.
*Call for an ambulance (dial 991 or a hospital direct line if known) or get someone to take you immediately to the nearest hospital.
*It is not safe for you to drive.
*Chew and swallow one 300mg table of aspirin immediately if you are not on regular aspirin and you have no history of allergy to aspirin.
In most cases, the cause of a heart attack is total blockage by a blood clot, and the most effective treatment is the immediate relief of the obstruction, by clot-dissolving medication, or even more effectively with coronary angioplasty which keeps the blood vessel open by the use of a stent.
Does having a heart attack change a person emotionally or physically? What are some of the most important key areas to focus on for a successful recovery?
Having a heart attack would change a person both emotionally and physically. It is therefore important to prevent heart disease (atherosclerotic) by adopting a healthy lifestyle (avoid smoking, keep to healthy diet, exercise regularly, keep a healthy weight), have regular check-ups, and regulate your blood pressure, cholesterol and sugar levels.
Following a heart attack, it is as important to ensure one lives a healthy lifestyle, with a healthy diet, keeping to a healthy weight, exercising regular, and ensuring blood sugar, cholesterol and blood pressure are below “target” levels.
Medications proven to benefit patients after heart attacks include aspirin, clopidogrel, betablockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins.
The chances of a patient suffering a second heart attack escalates if the person does not make lifestyle changes after the first heart attack.
It has been said that the heart is ‘damaged’ after a heart attack. Is that true? Once heart disease is treated, can it be cured?
A heart attack occurs when a blood clot develops at the site of narrowing in the coronary artery and cuts off blood supply to that part of the heart muscle. Cells in the heart muscle begin to die without oxygen-rich blood, which can cause permanent damage the heart muscle.
The earlier the victim gets treatment to relieve the blockage and reinstate blood flow, the less the damage to the heart muscle, and the better for the victim.
Heart disease generally cannot be “cured”. However, heart disease can be controlled by a healthy lifestyle and appropriate medications. Those with normal heart function and those with mild impairment of heart function can live a normal life.
How do you define ‘being cured’ for an individual who has suffered a heart attack?
Cured here would mean an impaired function returning to normal. Generally, if a narrowing in the blood vessel causes insufficient blood flow, we can improve the blood flow either by a balloon, stent or by bypass graft surgery.
If there is total blockage (as in a heart attack), there is cessation of blood flow to that part of the heart muscle, and unless blood flow is restored immediately (or there are pre-existing collateral blood flow), muscle damage would occur.
Muscle damage would result in scar formation and the scarred part of the heart muscle would remain permanent.
What are some of the latest breakthrough in terms of treatment of patients with heart disease?
On September 14, 2011, IJN was the first hospital in the country and in the Asia region to introduce catheter-based renal denervation treatment for patients with resistant hypertension. Resistant hypertension is defined as blood pressure above 160/90 mmHg or, in diabetics, above150/90 mmHg despite being on three or more blood pressure medications.
These patients are at residual risk of heart failure, stroke and premature death. The procedure was successfully performed on six patients suffering from resistant hypertension. The renal denervation procedure is based on research showing that overactive sympathetic nerves are a major contributor to the progression of high blood pressure.
Renal denervation involves selectively disabling sympathetic nerves on the surface of the renal/kidney arteries. Studies have demonstrated the safety and efficacy of the procedure for patients with resistant hypertension.
In addition to hypertension, the therapy may hold promise for treating heart failure, diabetes, chronic kidney disease and obstructive sleep apnoea.
These conditions are also characterised by elevated sympathetic activity.
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