, by DR. ANIS ANSARI
According to American Heart Association, Coronary Heart Disease (CHD) is the leading cause of death in the USA. The situation seems to be grim when we see patients with ages in the 30s and 40s dying of heart attack. Each year more than 500,000 Americans die of heart attack, 50 per cent don’t even reach the emergency room. According to World Health Organisation, the number of people dying from CHD will rise to 11.1 million by 2020. Direct and indirect cost of CHD is $112 billion.
There are 13.2 million people (4.85% of population) who have CHD in the USA. 1.2 million new cases of heart attack (or 100,000 per month) are added to the total every year. Prevalence is highest in black males (262 per 100,000) followed by white males then black females and white females. Males have heart attacks earlier in life and more men have them than women. However, more than 45 million women in the US are in the risky age range, and heart attacks may present fewer physical signs to women than men. Stroke will kill more women than men in the US.
Major risk factor for heart attack includes Diabetes Mellitus, high blood pressure, smoking, high cholesterol, obesity, and family history of early heart attack. There are some other important risk factors that contribute significantly to heart attacks. For example high level of C – reactive protein (CRP) which signifies inflammation or infection in the body. Sleep apnoea, stress, heavy alcohol intake, and lack of physical activity need to be treated aggressively and behaviour needs to be modified.
Plaque build up in the arteries is made up of fat, cholesterol, calcium. Over time, plaque hardens and narrows the arteries reducing its blood supply and oxygen carrying capacity to the vital organs. Over time the plaque can crack attracting platelets resulting in narrowing of the arterial lumen leading to heart attack and stroke. Therefore heart attack depends more on the rupture of plaque and not necessarily on the total occlusion of the arteries.
SIGNS AND SYMPTOMS
Chest pain, sweating, heaviness in chest, shortness of breath and the radiation of pain or numbness to left arm or jaw are the common symptoms. Many diabetics have heart attack without symptoms (Silent MI). Patients can have chest pain of many different reasons including chest bone inflammation, heart burn, or reflux, inflammation of lining of lung. Doctors after talking and examining the patient can determine if chest pain is coming from the heart or not. Some literatures have mentioned that 80 per cent of time chest pain is not from the heart. It has to be taken more seriously in patient with history of Diabetes, high blood pressure or obesity.
In order to prevent or delay the onset of heart attack, risk factors must be controlled or modified. Reduction of obesity, increase in physical activity to 30 minutes five days a week, healthy diet low in saturated fat to control high cholesterol, smoking cessation, and good control of diabetes and high blood pressure are crucial. In one recent study, regular exercise (30 minutes 5 days a week) was found to be superior to balloon angioplasty. A diet high in fruit and vegetables can increase important cholesterol lowering compounds in your diet. Fish, good source of omega 3 fatty acids is part of healthy heart diet which protects the heart.
Dietary Approach to Stop Hypertension (DASH) recommended reducing high blood pressure and focuses on fruit, vegetables, whole grains, and low salt diet. One new study in New England Journal of Medicine reported that cutting salt consumption to no more than one teaspoon everyday would prevent up to 120,000 heart disease cases, 65,000 strokes and save 92,000 lives in this country every single year.
Treatment of CHD includes lifestyle modifications, medications, and procedures such as balloon angioplasty and bypass. Work up usually starts with stress tests and ultrasound of the heart. If stress test is abnormal then the patient needs to have heart angiogram in order to know the extent of the blockage in the arteries. Balloon angioplasty can be performed at the same time. Those patients with chest pain at home should take an aspirin before going to the emergency room or to their doctor’s offices. Sometime for acute heart attack, clot busting medication is started in the ER while other times they need to have balloon angioplasty immediately. Patient with difficult anatomy and multiple vessel disease along with poor functioning of the heart may need procedure to bypass the clotted artery.
Ct scan of chest with IV contrast is as good as traditional angiogram for patient at low risk for coronary intervention. Coronary calcium score is another Ct procedure for screening of CHD.
American heart association has set out a goal of reducing cardiovascular health of all America by 20% while reducing death from heart attack and stroke by 20 % by 2020.
Individual efforts will go a long way in meeting that goal.
[Dr. Ansari is President of Islamic Society of Clinton County in Clinton, IA and a Board Certified Nephrologist. He can be reached at firstname.lastname@example.org.]