If you’re not careful with ischaemic heart disease, then be prepared for a heart attack.
ATHEROSCLEROSIS is a condition characterised by a thickening of the endothelium (inner lining of an artery). This causes the space inside the artery to narrow and flow of blood subsequently becomes restricted. The narrowing of the arteries causes ischaemic heart disease, which is the lack of blood supply to the heart muscle (ischaemia).
As atherosclerosis eventually leads to ischaemic heart disease, it is important to know the risk factors. They are divided into two categories. Modifiable risk factors are factors which we can control, such as raised cholesterol, hypertension (high blood pressure), diabetes, and smoking. Non-modifiable risk factors cannot be controlled, and these include advancing age, gender and genetic factors.
Although most people with an ischaemic heart have the same underlying problem, namely narrowing of the coronary arteries, the symptoms vary. Some may develop angina (chest pain), others may have a heart attack and yet others have heart failure.
Angina and heart attacks
Angina is the central chest discomfort brought on by exercise, but the pain goes away when you rest. It usually lasts about two to three minutes. Also, the pain may be present when you walk uphill or when you climb stairs.
During a heart attack, the pain is the same as angina except that it gets worse. Individuals who have gone through it says it is the worst pain they have felt in their lives. They appear grey, sweaty and feel cold when touched. They may also suffer from nausea and vomiting may occur.
The difference between an angina and a heart attack is that in angina, the heart muscle lacks oxygen but is undamaged. However, in a heart attack, the heart muscle dies due to the shortage of oxygen caused by a total occlusion of the coronary artery.
Detection of heart disease
It is important to identify the seriousness of the problem, and also to identify if you are really suffering from it! Other conditions such as indigestion, pleurisy, muscle pain, shingles, viral infections and cervical spondylosis (spinal degeneration and deformity of the joints) may also simulate angina and heart attack. The tests used to diagnose heart disease are:
1. Electrocardiogram (ECG). It is a test that measures the electrical activity of the heart. During the test, the electrical impulses made while the heart is beating are usually recorded and shown on a piece of paper. However, the ECG is usually normal if it is performed when the individual is resting or free from angina pain. For this reason, the exercise ECG (treadmill test) is more accurate as it brings out the symptoms and the ECG changes. Thus, this will confirm the diagnosis of an angina.
2. Radioactive Isotope Test. During this test, a radioactive substance such as thallium is injected into the body, which makes the heart and its vessels visible to a special camera. The test is useful as it is able to indicate viable heart muscles which takes up the isotope. This test can be done at both resting and exercising scenarios.
3. Stress Echocardiogram. The stress echocardiogram test is in principle the same as the radioactive isotope test, except that no radioactive substance is involved here.
4. Coronary Angiogram. This is the most direct way of detecting blockages in the heart. The test is done by injecting a radio opaque dye directly into the coronary artery. Although this is the best way of looking at coronary arteries, it is not necessary for everyone with angina or CHD (coronary heart disease) to run this test. It is used when it is likely required for the patient to undergo angioplasty or bypass surgery.
Treating heart disease
The aim of treatment of angina and heart attack is to increase the blood flow to the heart muscles. You may receive treatment in the form of medication and surgery.
For certain people, heart disease treatment can be achieved without surgery. Angioplasty is a non-surgical procedure that can be used to open blocked heart arteries. This is done by stretching the narrowed artery with a high-pressure balloon and it is very effective in certain situations.
Coronary bypass surgery (CABG) is performed when your coronary arteries are severely blocked. This is very effective in advanced disease. It is done by removing or redirecting blood vessel from one area of the heart and placed around the area or areas of narrowing to “bypass” the blockage and restore blood flow to the heart muscle.
Each treatment modality has its advantages and disadvantages. The doctor normally recommends a particular treatment after discussion with the patient.
Drugs that are taken can be remembered in the form of a mnemonic, A-B-C-A. Antiplatelets (aspirin), Beta-blocker, Cholesterol lowering drug (statin) and ACE Inhibitors.
Prevention of heart disease
It is still not too late to think about prevention through a healthy lifestyle. Regular aerobic exercise or brisk walking for at least 30 minutes on most days of the week coupled with a low-fat diet (less than 30% of total calories daily, consisting of 10% saturated fat, 10% polyunsaturated fat and 10% monounsaturated fat). The diet should also be high in soluble fibre (more than 70g) of oats and plant sterols (1.3g).
You should also consume carbohydrates (about 55% total calories) in the form of complex carbohydrates and protein (15% total calories), with cholesterol less than 200mg a day.
If you are a smoker, you should also give up smoking. Tobacco use decreases the level of HDL-C and increases the level of LDL-C in the body. Apart from that, cigarettes are loaded with “free radicals” that oxidises the LDL cholesterol that is absorbed into your blood vessels. Follow this changes in life, and give yourself a second chance to live.
This article is courtesy of The Heart Foundation of Malaysia (YJM). The author is a consultant cardiologist and also a Director of YJM. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
ATHEROSCLEROSIS is a condition characterised by a thickening of the endothelium (inner lining of an artery). This causes the space inside the artery to narrow and flow of blood subsequently becomes restricted. The narrowing of the arteries causes ischaemic heart disease, which is the lack of blood supply to the heart muscle (ischaemia).
As atherosclerosis eventually leads to ischaemic heart disease, it is important to know the risk factors. They are divided into two categories. Modifiable risk factors are factors which we can control, such as raised cholesterol, hypertension (high blood pressure), diabetes, and smoking. Non-modifiable risk factors cannot be controlled, and these include advancing age, gender and genetic factors.
Although most people with an ischaemic heart have the same underlying problem, namely narrowing of the coronary arteries, the symptoms vary. Some may develop angina (chest pain), others may have a heart attack and yet others have heart failure.
Angina and heart attacks
Angina is the central chest discomfort brought on by exercise, but the pain goes away when you rest. It usually lasts about two to three minutes. Also, the pain may be present when you walk uphill or when you climb stairs.
During a heart attack, the pain is the same as angina except that it gets worse. Individuals who have gone through it says it is the worst pain they have felt in their lives. They appear grey, sweaty and feel cold when touched. They may also suffer from nausea and vomiting may occur.
The difference between an angina and a heart attack is that in angina, the heart muscle lacks oxygen but is undamaged. However, in a heart attack, the heart muscle dies due to the shortage of oxygen caused by a total occlusion of the coronary artery.
Detection of heart disease
It is important to identify the seriousness of the problem, and also to identify if you are really suffering from it! Other conditions such as indigestion, pleurisy, muscle pain, shingles, viral infections and cervical spondylosis (spinal degeneration and deformity of the joints) may also simulate angina and heart attack. The tests used to diagnose heart disease are:
1. Electrocardiogram (ECG). It is a test that measures the electrical activity of the heart. During the test, the electrical impulses made while the heart is beating are usually recorded and shown on a piece of paper. However, the ECG is usually normal if it is performed when the individual is resting or free from angina pain. For this reason, the exercise ECG (treadmill test) is more accurate as it brings out the symptoms and the ECG changes. Thus, this will confirm the diagnosis of an angina.
2. Radioactive Isotope Test. During this test, a radioactive substance such as thallium is injected into the body, which makes the heart and its vessels visible to a special camera. The test is useful as it is able to indicate viable heart muscles which takes up the isotope. This test can be done at both resting and exercising scenarios.
3. Stress Echocardiogram. The stress echocardiogram test is in principle the same as the radioactive isotope test, except that no radioactive substance is involved here.
4. Coronary Angiogram. This is the most direct way of detecting blockages in the heart. The test is done by injecting a radio opaque dye directly into the coronary artery. Although this is the best way of looking at coronary arteries, it is not necessary for everyone with angina or CHD (coronary heart disease) to run this test. It is used when it is likely required for the patient to undergo angioplasty or bypass surgery.
Treating heart disease
The aim of treatment of angina and heart attack is to increase the blood flow to the heart muscles. You may receive treatment in the form of medication and surgery.
For certain people, heart disease treatment can be achieved without surgery. Angioplasty is a non-surgical procedure that can be used to open blocked heart arteries. This is done by stretching the narrowed artery with a high-pressure balloon and it is very effective in certain situations.
Coronary bypass surgery (CABG) is performed when your coronary arteries are severely blocked. This is very effective in advanced disease. It is done by removing or redirecting blood vessel from one area of the heart and placed around the area or areas of narrowing to “bypass” the blockage and restore blood flow to the heart muscle.
Each treatment modality has its advantages and disadvantages. The doctor normally recommends a particular treatment after discussion with the patient.
Drugs that are taken can be remembered in the form of a mnemonic, A-B-C-A. Antiplatelets (aspirin), Beta-blocker, Cholesterol lowering drug (statin) and ACE Inhibitors.
Prevention of heart disease
It is still not too late to think about prevention through a healthy lifestyle. Regular aerobic exercise or brisk walking for at least 30 minutes on most days of the week coupled with a low-fat diet (less than 30% of total calories daily, consisting of 10% saturated fat, 10% polyunsaturated fat and 10% monounsaturated fat). The diet should also be high in soluble fibre (more than 70g) of oats and plant sterols (1.3g).
You should also consume carbohydrates (about 55% total calories) in the form of complex carbohydrates and protein (15% total calories), with cholesterol less than 200mg a day.
If you are a smoker, you should also give up smoking. Tobacco use decreases the level of HDL-C and increases the level of LDL-C in the body. Apart from that, cigarettes are loaded with “free radicals” that oxidises the LDL cholesterol that is absorbed into your blood vessels. Follow this changes in life, and give yourself a second chance to live.
This article is courtesy of The Heart Foundation of Malaysia (YJM). The author is a consultant cardiologist and also a Director of YJM. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Heart attacks are less likely for non-smokers as compared to the smokers. According to WHO, individuals who quit smoking decrease their risk of CAD one year later by 50 %. If you have quit smoking, for 15 years, your risk of dying from CAD is almost as low as a life time non-smoker. http://www.chantixhome.com/
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