GetDoc: Heart disease is the number one leading cause of death among Malaysians, what are the rules-of-thumb for a regular person to take care of his or her heart?
Dr Sivarani: Heart disease, or more precisely, coronary artery disease is indeed one of the leading cause of death among Asians and Europeans. There are many risk factors to the development of coronary artery disease.
Cardiovascular risk factors are divided into the modifiable and non-modifiable risks. Modifiable risks are smoking, alcohol consumption, obesity, dyslipidemia, hypertension, diabetes mellitus and stress.
The non-modifiable cardiovascular risk factors are age (males >45 years; females >55 years), gender (males carry a higher risk than females) and family history of premature coronary artery disease.
The modifiable risk factors need aggressive lifestyle modification, compliance to medications and continued followup visits to the doctor for continued treatment and assessment on the control of these factors. Lifestyle modifications includes cessation of smoking and alcohol consumption, regular exercise and avoidance of sedentary lifestyles, adoption of healthy eating habits and stress management.
GetDoc: Is diet and lifestyle major causes of heart disease?
Dr Sivarani: Yes, in the context of coronary artery disease. Unhealthy eating habits that contribute to unhealthy diet is a major contribution to coronary artery disease. Diets rich in sugar, salt and cholesterol will predispose an individual to the development of diabetes mellitus, hypertension and dyslipidemia. All these conditions increase the risk of developing coronary artery disease. Thus, a balanced diet consisting of carbohydrate, protein, fruits and vegetables will be able to provide the necessary nutrition for sustaining good health.
Sedentary lifestyles and smoking causes cholesterol buildups in the coronary arteries, thus increasing the risk of heart attacks.
GetDoc: Is there any difference between heart disease and cardiac arrest?
Dr Sivarani: Heart disease is a broad term that takes into account all the diseases of the heart. Heart diseases are classified into few main groups, namely, coronary artery disease (a term that denotes blockages of the arteries of the heart), valvular heart disease (a term that denotes the dysfunctional heart valves), cardiomyopathies (a term that denotes the dysfunctional heart muscles) and cardiac arrhythmias (a term to denote abnormal heart rhythms).
On the other hand, cardiac arrest denotes the cessation of the pumping of the heart. As we all know, the heart needs to pump continuously for us to live. Thus, everyone who dies develops a cardiac arrest. This may be due to multiple causes that do not necessarily originate from diseases of the heart.
GetDoc: Its still shocking to hear of a perfectly healthy individual of a child going into cardiac arrest. How do we put this into perspective?
Dr Sivarani: Yes. This is what we call Sudden Cardiac Death(SCD). This is most likely due to abnormal heart rhythms which may not have been diagnosed earlier. Abnormal heart rhythms cause the heart to pump inefficiently and if the abnormal heart rhythms persist, the heart may stop altogether, thus leading to cardiac arrest. Some individuals may have abnormal conduction pathways in their heart which predispose to abnormal heart rhythms. However, this is often difficult to diagnose as this condition may be silent and patients may not exhibit any symptoms until a cardiac event as described above occurs.
However, in some presumably healthy individuals, early identification may be possible by identifying the risk factors for SCD. These risk factors include increasing age, coronary artery disease (with or without prior heart attack), a personal history of arrhythmias (abnormal heart rhythms) or revived sudden cardiac arrest, a personal or family history of sudden cardiac arrest or inherited disorders that predispose to sudden cardiac arrest, heart failure, unexplained fainting episodes, smoking, drug or alcohol abuse.
GetDoc: How do we prevent heart disease?
Dr Sivarani: Heart disease, like any other diseases, cannot be fully prevented. We can only reduce our risk of developing heart disease by modifying and treating the modifiable risk factors. However, in patients with a strong family history of heart disease coupled with other non-modifiable risk factors, the risk of heart disease will remain high.
Nevertheless, public education plays an important role to create awareness amongst them. This can be done via health talks at events / functions, clinics / hospitals; and the distribution of health brochures to the patients and the public. Education on the importance of lifestyle modification that will improve health outcomes by decreasing the risk of heart attack, stroke, heart failure and sudden cardiac death.
Doctors will also have to treat hypertension, diabetes mellitus and dyslipidemia aggressively to reduce the risks of developing heart disease. Patients need to be repeatedly re-inforced on the importance of compliance to the medications prescribed and to continue followup visits with the doctor for regular monitoring of their health status.
GetDoc: How does one help himself during cardiac arrest? When should one consult a cardiologist for heart problems?
Dr Sivarani: The patient cannot help himself during a cardiac arrest because cardiac arrest is the cessation of the pumping of the heart. That will almost immediately be fatal. However, the patient should consult a cardiologist if he has symptoms such as chest pain, breathlessness, dizziness, leg swelling, lethargy, palpitations or fainting spells. Such symptoms may point towards heart disease. The earlier the patient is assessed, diagnosed and treated, the better the health outcome.
GetDoc: What are the emerging areas of cardiovascular innovation?
Dr Sivarani: The field of cardiology is constantly evolving. Amongst others, recent advancements include newer pills to thin the blood with significantly lower risks of bleeding and increased safety profiles. These medications are given to patients who have increased risks of blood clot formation in their hearts; to reduce the risks of a stroke due to that blood clot travelling to the arteries of the brain. In patients who are unable to tolerate these blood thinning pills, a special device known as the Watchman device can be implanted into the part of the heart where blood clot commonly forms, to reduce the risks of blood clot formation.
Another important breakthrough in cardiology is the release of the bioresorbable stent. This is a fully dissolving stent approved for the treatment of coronary artery disease. This stent is made of a naturally dissolving material that disappears completely in approximately 3 years after it has done its job of keeping a clogged artery open. By contrast, metal stents are permanent implants that stay in the arteries of the patient throughout his life. The absence of metal after it has fully dissolved in the artery may reduce the potential of future blockages that may occur with permanent metallic stents. However, long term outcomes of this stent have yet to be established.
The replacement of the aortic valve via a minimally invasive surgical procedure called Transcatheter Aortic Valve Implantation (TAVI) has been introduced. Although open-heart surgical aortic valve replacement is still the standard form of treatment for most patients with severe symptomatic aortic valve stenosis, TAVI is successfully perfomed in selected group of patients who are unable to tolerate an open- heart surgery. TAVI carries a lower death rate and lower stroke rate as compared to surgical aortic valve replacement.
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Qian's interest in healthcare industry came about after her father was diagnosed with bladder cancer. This experience has led her to become a strong believer in empowering individuals to take charge of their own health. View all articles by Qian.