WORLD HEART DAY - SEPTEMBER 25
Look after your heart
Dr. SANJIVA WIJESINHA
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Your heart won't fail before its time unless you allow it to fail!
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Prevention is the best treatment: Lead a healthy life, have a healthy heart. Photo: V. Sreenivasa Murthy
AMONG the commonest causes of death in India are heart attacks and heart failure. Heart attacks occur if blood flow to part of the heart muscle is suddenly cut off — usually because a clot is stuck inside a narrowed artery supplying blood to the heart (coronary artery).
Angina, aptly termed "a cry for help from the heart", describes the initial cramping pain in the heart when it doesn't receive enough oxygen-carrying blood. Typically a dull pain or discomfort in the centre of the chest brought on by physical exertion, strong emotion, a heavy meal or cold weather, angina usually subsides when the precipitating action or event ceases. The sensation feels different in different people — common descriptions are "chest tightness", "a heavy weight pressing on my chest" and "a hollow feeling". It can spread to the shoulder, upper arm, jaw or throat — and may be accompanied by sweating, nausea, shortness of breath or light-headedness. Angina is actually a warning that the coronary arteries are narrow, and if neglected, could well progress to a fatal heart attack.
Risk factors
Chest pain of this type almost always indicates that the coronary arteries are blocked. It is more likely to be experienced by smokers, diabetics, those who are overweight or have high blood pressure or cholesterol.
Anyone with these risk factors for heart disease who experiences angina, must get themselves checked by a doctor. Even doctors may not be sure that this is Angina, so blood tests and ECGs will be required. Sometimes, a special ECG taken while exercising (Exercise Stress ECG) will be required.
Doctors have many medications that can help. Glyceryl Trinatrate (GTN spray or Anginine tablets) helps relieve angina. Other tablets can dilate the coronary arteries and improve blood flow to the heart muscle, while beta-blockers can slow heart rate and reduce its demand for oxygen. A daily dose of aspirin reduces the "clottability" of blood and prevents clot formation in narrowed arteries.
If the arteries to the heart are significantly blocked, some form of surgery — either Angioplasty (to widen narrowed vessels) or Bypass Grafting (to replace diseased vessels using normal arteries from the arm or chest wall) — can be undertaken.
Heart failure has negative connotations — suggesting the heart is so weak that it is likely to breakdown and stop working at any moment! Since the basic function of the heart is to pump oxygen-containing blood around the body, "Heart Failure" simply means that the heart is failing to meet this demand. It can only make half-hearted contractions — so blood circulation is much more sluggish.
This happens because the heart (a chamber made of strong muscle that contracts over 100,000 times each day) suffers some form of damage that weakens the muscle. Damage may occur from a heart attack — the sudden stopping of blood flow to a portion of heart muscle damages it; repair is effected by replacing the dead muscle with fibrous tissue, leaving the heart weakened and unable to pump effectively.
Uncontrolled high blood pressure is dangerous — the heart wears itself out pumping against a high pressure gradient. Too much alcohol can result in the heart muscle becoming progressively flabby and unable to contract forcefully (Alcoholic cardiomyopathy).
The typical symptoms of heart failure are fatigue, breathlessness and generalised swelling of the body. Because adequate oxygen-carrying blood doesn't reach the cells, they cannot function properly — making one feel fatigued and lifeless. Breathlessness occurs because the sluggish circulation allows fluid to leak out of blood vessels into the lung tissue, "water-logging" the lungs which then cannot absorb oxygen from the inspired air into the bloodstream.
Vicious cycle
A vicious cycle is established because less oxygen is available for the already slow-moving circulation to carry. Swelling, particularly of the lower legs, is also due to fluid leaking out of vessels into the soft tissues of the most dependent parts of the body. By lying down or elevating the feet, the effect of gravity is lost and fluid gradually returns to the circulation.
Thanks to modern medical care, many people now survive heart attacks that would have killed people 50 years ago. These survivors need ongoing medical care to prevent the damaged heart from getting further damaged and gradually failing. Moreover, we now have more people living into their seventies and eighties — by which time age and the inexorable passage of time takes its toll, weakening the heart's pumping ability. Managed properly, someone with heart failure can look forward to many years of quality life. But if neglected, it leads to repeated exacerbations requiring expensive admissions to hospital.
The aim of treatment is to alleviate symptoms, prolong good quality life and reduce hospital admissions. The best treatment, of course, is prevention, and looking after yourself to prevent yourself getting a heart attack, having your blood pressure checked regularly and keeping it under control, and ensuring that you don't allow alcohol to damage your heart are all easy ways of preventing a failure. Treating heart failure today requires both non-medical and medical methods. Staying active with regular exercise "within the limits of your capability" is important to improve circulation — as is taking a suitable salt-free, anaemia-preventing, low fat diet.
As for medicines, what is most important is to regularly take the medications prescribed for you. If some tablets don't agree with you, don't stop taking them- discuss the side effects with your doctor, because your doctor can often provide an alternative.
Some medications are designed to strengthen the heart's pumping action, others to extract fluid from waterlogged lungs and feet. Certain tablets replace vital electrolytes, others improve blood flow to vital organs.
E-mail the writer atSanjiva.Wijesinha@med.monash.edu.au
Self-help
If you do prove to have narrowed coronaries, you can help yourself
By reducing weight if overweight - this reduces the workload on your heart
By stopping smoking — otherwise your arteries will continue to get narrower
By exercising regularly — because this will improve the blood flow to your heart
By relaxing and cultivating a sense of equanimity — which have been proved to reduce episodes of angina.
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