To understand Cardiovascular Disease, you must first understand the Cardiovascular System that makes up the network which transports blood throughout the body. It is in fact, our body’s lifeline! This system is made up of the heart that pumps around oxygen rich blood through arteries and receives oxygen poor blood via the veins. The heart is the key organ in the circulatory system.
When we speak of Cardiovascular Disease, this describes diseases of the heart and the arteries, including arteries to the brains, causing stroke.
Dr. Meredith Sedney talked about heart diseases on the SMMC Radio Program Care Connect on Monday January 25th, 2016.
“Heart disease and Stroke are the top causes of death in the world, comprising more than 30% of all deaths. This is far more than cancer for instance. And they will continue to dominate the number of deaths. What we see now in St. Maarten is just the tip of the iceberg. But the good news is that it is manageable and preventable. Early detection is lifesaving”.
What is heart disease. Is it inherited?
There are several diseases of the heart:diseases that affect the muscle of the heart, called cardiomyopathy; arrhythmias causing an abnormal heart rate and rhythm. There are cardiomyopathies that are not caused by high blood pressure or diseases of the heart vessels (that supply blood to the heart itself); some of those are inherited.
But the heart disease with the highest number of death is called ischemic heart disease or coronary artery disease leading to what is generally called heart attacks. It occurs because one or more of the arteries supplying blood to the heart muscle itself become blocked. Those need early, sometimes urgent treatment. Therefore we should focus on that type of heart disease.
What is a heart attack?
The underlying cause of the blockage is that fatty material (called plaque) that are deposited inside the blood vessels making it narrow and thereby making it harder for blood to flow to the heart muscle. This can cause chest pain especially if more oxygen to the heart is needed at a certain time, for instance during exercise. Eventually, the plaque can rupture, triggering the formation of a blood clot which closes the vessel to the heart muscle totally, which in turn damages the heart muscle. This can lead to sudden cardiac death or failure of the heart muscle to pump the blood around.
If it develops in the arteries which supply blood to the brain, it can cause a stroke.
Factors that promote the process of blockage are known as risk factors. They include: high blood pressure, high cholesterol, diabetes, smoking, physical inactivity and being overweight, stress and excessive alcohol consumption. These factors are all manageable and preventable.
There are some risk factors that cannot be changed: ageing, gender, family history. Cardiovascular disease becomes common with advancing age; a man is at greater risk of heart disease than a pre-menopausal woman. After menopause, the risk is greater for having a heart attack, even more than men. The drop in estrogen hormones may be a factor in heart disease.
There is also an increase in the risk of a heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke, mainly seen when the relative has had a heart attack before the age of 55.
Obviously, you cannot change your family history but a family history of heart disease should suggest the need to improve all the other risk factors.
What are the signs and symptoms of a heart attack?
A classic heart attack causes chest pain; pressure-like pain. Chest pains usually start when you exercise and it goes away when you stop, later your chest pain can increase and take longer to go away even after you stop exercising. Sometimes the pain radiates on your left arm, going through the fingers. It can also radiate on your jaw, back of the head and stomach. Those are warning signs.
If these symptoms last for more than half hour and they do not go away by itself, then you should think, ‘Could I be having a heart attack?’ Also be aware if, when in addition to chest pain, you feel nauseas and you sweat.
Of course not everyone with chest pain would be having a heart attack, so you should also consider ‘Do I have risk factors or a family history with heart attacks?’
I was made aware of the acronym: HONDAS- Hypertensive, Overweight, Noncompliant, Diabetic, Alcoholics and Smoker, that can easily be remembered as the most important risk factors.
What are the signs and symptoms of a stroke?
There are two major kinds of stroke; ischemic and hemorrhagic. In an ischemic stroke, the blood vessels are blocked and a portion of the brain lacks oxygen and stops functioning. In a hemorrhagic stroke, there is a bleeding in the brain which can sometimes be as a result of an ischemic stroke.
Stroke usually happens suddenly, you have lured speech, you cannot use your arms on one side and you have headache, nausea and vomiting. There is also an acronym for this F.A.S.T.
- F. Does one side of the face droop? Or is it numb? Ask the person to smile. Is the smile even?
- A. Is one arm weak or numb? Ask the persons to raise both arms. Does one arm drift downwards?
- S. Is the speech slurred? Ask the person to repeat a simple sentence. Is the sentence repeated correctly?
- T. Time to call 912 if someone shows these symptoms. Check the time so you know when the symptoms first appeared.
Is heart attack and stroke related?
No. However they usually have the same underlying vessel disease. The most common cause of that is high blood pressure with or without diabetes.
So persons with a family history of heart disease or stroke should monitor their health figures regularly…
Yes, certainly those with other risk factors especially blood pressure; which is a major problem on the island. At least half of our patients in the hospital suffer from high blood pressure. And people in general do not like to take medication. They tend to say “I don’t want to get used to it”.
The thing is that when you have high blood sugar, you may feel odd, but with high blood pressure you may not notice anything, for years even, and that is why it is called the silent killer. That is also why patients do not take the prescribed medication. In general male patients are afraid to take medication because of the alleged side effects of erectile dysfunction.
It is also a misconception that you can stop the medication if the blood pressure is okay. Blood pressure will rise again if medication is stopped.
In the Caribbean a lot of persons would prefer to use herbal remedies instead of medication. Do you notice that, what do you think about this?
I have noticed that. Yes we see the preference for herbal remedies a lot. I personally do not have a problem with that, for some persons it works, but if it is not working then it is important that the patient continue with medication to regulate his or her health status.
What should you do if you think you are having a heart attack?
Call the ambulance and make sure that you will be seen urgently in the ER of the hospital. Nurses and doctors will evaluate within a half hour if you need urgent medication that dissolves the blood clot to restore the flow of blood through the heart muscle. Blood tests and an electrocardiogram will show if you have a serious heart attack.
There are several categories of patients with regard to further treatment and investigations. Those who are critically ill and need to be send away by air ambulance, those who can go later by commercial flight and those who are well treated with medication. The cardiologist can make that decision.
How can prevention help?
Fortunately I see much more people exercising in the last few years, just walking forcefully along the road, and that is a good thing to start with. Every type of exercise will do- dancing, swimming, even household and gardening-, as long as you come out of that chair regularly. At least 30 minutes each day can have remarkable outcomes for your health.
Within 90 days you will see the beneficial effects which are weight loss, lowering blood pressure if it is high, lowering blood sugar and lowering the bad cholesterol. Exercising regularly will lower the mortality by 25%.
The St. Maarten Heart and Stroke Foundation brings awareness to the illness and that is also a good start.
Finally, it is very important to be aware of the signs and symptoms of heart disease. If you know that, you can come to the doctor at the earliest moment. The earlier you attack the problem the more positive your results may be.
What is patient care like in the hospital for cardiology patients?
Cardiologists provide care for all heart related diseases and are also in consultation for stroke patient because of the relationship with the vessels and possible arrhythmias.
In the outpatient department of SMMC, we can evaluate the majority of heart diseases and whether the blood vessels of the patients are okay or not. With an electrocardiogram, a stress test, an echocardiogram and our stethoscope we can make accurate diagnosis.
Looking into the arteries of the heart cannot currently be done in SMMC, because we do not have the facilities for that. Until then, we have the nearest option of referring our patients to the “Hartcentrum Curacao” which provides good quality of patient care and cure at a desired level. If a patient would need open heart surgery we can, in close collaboration with your health insurance company timely refer to centers where that can be done.
If the electricity in the heart is not normal and the patient needs a pacemaker, it can be implanted by the cardiologist and checked by a specially trained nurse in SMMC.
What is needed for prevention is measuring the amount of calcium in the heart vessels. It can predict life expectancy and estimate the risk of getting a heart attack. There is a lot we can do at the SMMC and cardiology service is a relatively new specialty at the hospital. We are glad that we can offer that care to patients close to home.