Every year September 29 is celebrated as World Heart Day, and the focus this year for the World Heart Foundation is ‘Use heart for every heart’.
Cardiovascular Diseases (CVDs) are a leading cause of deaths in India, with some estimates showing one in four deaths attributed to CVDs. According to current estimates India has the CVD capital of the world. Stories of patients in their 30s and 40s succumbing to heart disease, unfortunately, have become frighteningly commonplace.
A Stich In Time…
When it comes to one’s health, especially heart health, the adage ‘A stitch in time saves nine’ is apt. There is a tendency, at least among a few, to avoid regular health check-ups. When your car needs regular servicing/check-ups, how can it not apply to something way more complex such as the human body, especially the heart!
To understand its importance, picture this: the heart beats about 100,000 times in a day, and about 35 million times in a year. During an average lifetime, the human heart will beat more than 2.5 billion times! This underscores the importance of regular check-ups.
Along with regular check-ups, it is important to follow a systematic, clean, and alert lifestyle. Mild to moderate exercise of about 30 minutes five times a week is recommended. Avoid sitting for prolonged periods of time — those in desk-facing jobs need to take regular, short breaks. To the extent possible, eating healthy is a must — avoid processed, sugars, oils, and animal fat-based foods. It is equally important to manage stress, and to clock at least seven hours of good sleep daily. Those who smoke tobacco-based products are at a higher risk of heart ailments, and this should be avoided.
Those who have co-morbidities, such as hypertension (blood pressure), high cholesterol, and/or diabetes need to be even more vigilant about heart-related problems.
That Discomfort
An extension of being alert is to know the symptoms associated with a cardiac arrest, and what to do in the event of a heart attack — because it could happen anywhere, anytime.
The symptoms include chest pain (discomfort). While it is classically described as crushing/pressure, these symptoms can be atypical, especially in women. Often times, it is just a sensation of shortness of breath, fatigue, or just not feeling right. Any discomfort that is present for a few minutes without resolving ought to be evaluated urgently in a hospital.
In the event of such discomfort, do not wait to report it to your doctor till the next appointment. This is an emergency. Take a full dose of aspirin, and get to the nearest hospital, preferably by ambulance. Get someone else to drive you if an ambulance is not available.
Doctor, How Did This Happen?
It is important to know what tests such as the electrocardiogram (ECG) and echocardiogram (Echo) mean. It is not unreasonable to get ECGs as we get older, and to be more aggressive than what the Western guidelines recommend, given our higher prevalence to heart ailments.
An ECG can pick up in certain cases if the patient has had heart attacks, and can be invaluable in picking up certain problems when one is having a chest pain. A normal ECG does not preclude having an undiagnosed blockage in the heart vessel (which could lead to a heart attack). Similarly, an Echo only tells you how the pump is, and how the valves are — it does not diagnose the blood vessel supply to the heart. A coronary CT or an angiogram is what shows the blood vessel supply to the heart.
All this does not mean that a layperson can turn to these tests and diagnose oneself. The key idea is that a regular check up with one’s healthcare provider or with a cardiologist might be warranted to truly optimise one’s cardiac health.
Tough Calls
It is important that any interventional procedure is only done when the potential benefit outweighs the risk of the procedure. The problem is that patients are often told it is better to not undergo any procedure because of the ‘risk’ involved. What is often unsaid is that there is bigger ‘risk’ in doing nothing! It is these higher-risk patients who often derive the most benefit from these procedures.
It is often the case with complex heart disease, and extensive blockages to have diverse recommendations based on the same test report. There is a widespread misconception that patients with far advanced CADs often derive no meaningful clinical benefit. Paradoxically, studies have suggested that for the high-risk coronary disease patients appropriate revascularisation (along with good medical therapy) can help improve both quality of life and reduce adverse clinical events.
Sometimes recommendations are based on outdated studies, or the cardiologist’s own procedural skillsets (or biases). Hence, unfortunately, patients are told what the doctor can do, and not what the patients need. A question that I have often asked when teaching complex angioplasty is: “If we as interventionalists knew getting into the procedure that we would not fail, which patients/procedures would we take on?”
Science On Our Side
Today the science in the procedures and the technology assisting the doctor has advanced tremendously that the success rate in complex operations (where there are 100 percent blockage in the blood vessels) is over 95 percent.
Complex and technically-demanding procedures such as retrograde and antegrade dissections can be done today. Experts who have done hundreds, if not thousands of these procedures, are comfortable switching between various strategies even during a procedure, thereby leading to a high success rate.
Coronary artery disease should not continue to be the top ailment. A healthy lifestyle, and preventive measures can significantly reduce the risks that lead to heart problems. Do not be afraid to ask questions to your heart doctor both about the procedure, as well as the doctor’s qualifications. Do not ignore symptoms at any point of time. Finally, any blockage can be treated/opened — do not let anyone tell you there are no options.
This World Heart Day let’s take a decision to increase our awareness, for being aware is a strong first step.