Kota Kinabalu: Heart disease and heart attacks are the number one cause of death, both worldwide and in Malaysia. Every day in Malaysia, an estimated 50 people die as a result of a heart attack (right) or heart disease.
Heart disease is caused by hypertension, smoking, high cholesterol and type 2 diabetes. It is also commoner as we get older, and in men.
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As you are reading this, take the time to assess yourself… if you have three or more of the risk factors mentioned above.
When talking about heart disease, we mainly mean blockages or narrowings inside the vessels that supply blood to the heart. Blood is essential for the body of work normally, as it is the fuel for the body.
Think of the blood vessel like a pipe, carrying blood to the parts of the body. Certain risk factors such as hypertension, smoking and diabetes cause direct damage to the inside of the blood vessel, resulting in cracks in the wall.
The body tries to repair these cracks by sealing them over with cholesterol. Unless the risk factors are controlled, this injury will repeat eventually causing a build up of the cholesterol, leading to narrowings or blockages.
When there are narrowings or blockages, the amount of blood that can reach the heart will be insufficient, especially when the heart is working hard; for example during exercise.
When this happens, the heart will begin to struggle and hurt. This is why chest pain, difficulty breathing and reduced level of activity are the main symptoms for heart disease.
When a narrowing develops slowly over time, the symptoms also develop slowly over time. The first signs of trouble occur during heavy physical activity such as climbing or running, and disappears when you rest.
This is called stable coronary artery disease. As the narrowings worsen, the signs also appear much earlier, and eventually can occur even with light work.
Sometimes the blood vessel can block of completely without any warning. This usually happens when the cholesterol that has built up inside the blood vessel bursts open.
Blood passing by the burst cholesterol reacts by forming a clot, which can completely block the blood vessel. This is a heart attack. A heart attack is a medical emergency, and untreated has a high risk of death, or permanent damage to the heart muscle resulting in heart failure.
In a heart attack, the symptoms are the same; chest pain, shortness of breath, excess sweating; but occur without warning and are usually much worse. If this occurs, it is critical you go to the nearest hospital to seek medical treatment.
The longer you delay going to the hospital, the more damage will occur to your heart and the higher the likelihood of dying or developing heart failure.
When a clot has blocked off a blood vessel, there are two possible treatments.
The first treatment is to give an injection that can dissolve the clot and restore the blood flow to the heart. This treatment works best if you can get to the hospital within 4 hours of the onset of the heart attack. This is because the clot is still soft, and has a much higher chance of dissolving with the treatment.
As time goes by, the clot becomes more solid, and with that the injection may not work as well. Unfortunately this treatment may not be suitable for everyone, because the injection may cause bleeding to occur, for example within the brain or in the abdomen.
The second treatment is to do emergency angioplasty. A small tube is passed through the leg or arm up to the heart. Special dye is injected into the blood vessels of the heart which can be seen on an X-ray.
This will show where the clot is, and it can then be removed, or pushed to the side, to allow normal blood flow to resume. This treatment has been shown to be effective up to 12 hours from the onset of the heart attack.
However, this can only be done in certain hospitals, all of which are in Kota Kinabalu.
Any longer than 12 hours from the onset, the damage is likely to be permanent, and the heart muscle will be unlikely to recover. In this stage, you will develop worsening shortness of breath, as fluid builds up in the lungs and in the legs.
At this point, restoring the blood flow is unlikely to help. It is, therefore, critical to seek treatment as soon as possible, to avoid this situation.
If you develop the symptoms mentioned above, and you reside more than 12 hours away from Kota Kinabalu, please go to the nearest hospital to seek treatment.
The sooner you go the better the possibility of recovery. Do not go directly to Kota Kinabalu because by the time you arrive, the damage will be permanent. Once you have been treated, then you can come to Kota Kinabalu for further treatment.
Finally, the most effective way to avoid a heart attack is to identify what risk factors you have, and to treat them. Effective treatment of hypertension, diabetes and high cholesterol will reduce the risk of heart attack by as much as 50 per cent.
Hypertension and high cholesterol do not have any symptoms, until you already have narrowings or blockages. The only way to find out is by doing a check up and blood tests.
Recent studies have shown that early identification and treatment of hypertension, diabetes and high cholesterol are most important at preventing heart attack and death.
Coronary Angiogram and Angioplasty can be used in cases where the chest pain or breathlessness is still troublesome.
“An ounce of prevention is worth a pound of cure.” –
Benjamin Franklin
This article was contributed by Dr Ahmad Ashraf who is the resident consultant Interventional Cardiologist at Gleneagles Hospital Kota Kinabalu.
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