Coronary Heart Disease ( CHD) which was the focus of World Heart Day on September 29, continues to be a major public health concern in Sri Lanka. The latest World Health Organisation (WHO) data of 2017 has cited that CHD deaths in Sri Lanka now ranked Number 72 among the top countries with coronary heart disease deaths. Given the fact that Sri Lanka has an ageing population considered more vulnerable to heart disease than the younger population, due to various other health related issues they already have, could have compounded this risk. At the same time, better data recording and better statistics as well as more awareness raising which has encouraged more people to get themselves checked early could also have been a reason for this spike.
However, the basic fact remains that heart disease and deaths from CHD will continue to figure high among the causes for natural deaths in this country in the indefinite future - unless everyone of us does something positive to halt its dangerous trend. Starting with healthy lifestyle changes, leading stress free lives, avoiding starchy high cholesterol diets and exercise – plenty of it in the form of walking, running jogging, every day can prevent premature deaths caused by CHD and strokes . Collectively, they can be the key to helping you to live longer and enjoy heart healthy lives.
Cardiac Surgeon, Karapitiya Hospital, Dr Namal Gamage shared his views on how this can be done by following some inexpensive simple rules that can not only prevent a heart attack, but minimise the risk of complications in a patient who has already suffered a heart attack.
Excerpts from his interview with the Sunday Observer…
Q. On September29 the world collectively focussed attention on Coronary Heart Disease. According to the latest WHO data of 2017, Coronary Heart Disease ( CHD) deaths in Sri Lanka reached over 28,000 ( over 22%) of total deaths ranking Sri Lanka as No 72 among the countries with the highest number of coronary heart disease deaths. How do these figures compare with the figures you saw a decade ago?
A. The leading cause for natural deaths i. e. deaths not caused by accidents has remained the same in the last few decades and that is coronary heart disease as you mentioned. It may remain the same most probably in the future also at least for a few more decades.
Q. Out of a listing of 20 top causes for death in Sri Lanka , the same report puts CHD as the topmost cause. What has triggered this spike?
A. As I mentioned CHD is the topmost cause in the past, present and in the future.
Q. Could the fact that our population, especially, those over 55 years has gone up and people are living longer and data recording and statistics are better, also be contributory factors?
A. Yes, better treatment for CHD also has contributed to the increase of elderly population.
Q. Do you see more people attending your clinics due to more awareness raising?
A. Yes. Due to health education from various sources, especially, educated people attend seeking advice more and more.
Q. It has been said, polluted environments caused by vehicular traffic and toxic petrol fumes also play a big role in the increasing number of heart diseases. Is there a link?
A. Yes, polluted environment increases inhalation of carbon monoxide and such places disturb mental harmony in people living in them. Both are contributory factors for heart disease.
Q. Hospital admissions indicate that the age of patients is much younger than it was about ten years ago. What is the average age of those at highest risk of getting a heart disease today, compared to before?
A. Generally, this starts from early middle age and gradually increases, with time. Due to more sophisticated diagnostic tools available today one can see this shifting to younger age, more and more.
Q. Despite heart diseases being widely prevalent in Sri Lanka, many people still remain ignorant about how they are caused and how they can be identified, often mistaking the early symptoms for angina , gastritis or a passing chest pain caused by sleeping in an awkward position. Your comments?
A. My advice is that any chest pain which has no straightforward simple reason must be considered as coming from the heart and medical advice must be sought.
Q. Are cardiac diseases and stroke linked?
A. Yes, both have the same causative factors. They are both micro vascular diseases.
Q. What is Ischaemic Heart Disease?
A. Ischaemic heart disease is the disease caused by ischaemia to the heart muscle or myocardium caused by inadequate blood supply to the same, due to narrowing of coronary arteries which are the arteries for the myocardium.
Q. Can someone with a history of heart diseases in the family be more susceptible to it?
A. Yes familial tendency is a big contributory factor .
Q. It has been reported that 65% of all deaths in Sri Lanka are caused by non communicable diseases ( NCDs) . What are the NCDs that make a person with these pre-disposed conditions more vulnerable to heart disease? Hypertension? High cholesterol? Diabetes?
A. Yes, hypertension, diabetes, hyper cholesterolaemia and a few other uncommon metabolic diseases, especially, when not properly controlled play a big role. The message should be that if you have any of these you must control them with great care.
Q. Today, we live in a world of fast foods, fast paced lives and invasion of modern technology, such as, the computer, internet and television. This has resulted in less people adhering to healthy habits. Are unhealthy lifestyles and lack of exercise contributory factors to precipitating heart diseases?
A. Yes, all of them put your body chemistry into disharmony and in addition having a direct role they can play an indirect role by leading to diabetes, hypertension, hyper cholesterolaemia as well.
Q. Once you get a heart attack can it recur?
A. Yes, once you get a heart attack you are more prevalent to get the second one and the risk increases rapidly with the increasing number of heart attacks.
Q. How do you treat heart disease? Is it individual specific, or a blanket treatment for all?
A. Always individual specific. Treatment modalities must be well considered according to the patient parameters. Blanket treatment is for prevention only.
Q. Can a person with a mild attack be treated at home? How?
A. Never, never and never. The severity of a heart attack cannot be detected by physical means as is likely to happen if the patient is treated at home. Always take the patient to a qualified medical care unit as soon as possible, as soon as any suspicion arises.
Q. Alternative treatments like homeopathy and native drugs and herbs have also been tried out by some patients with alleged success. Your comments?
A. Any treatment must be scientifically proven. Till then None , I repeat None , should be believed.
Q. What emerging trends in heart diseases do you see today? e.g. Is paediatric cardiac disease on the increase?
A. The picture remains virtually unchanged , except for rheumatic heart disease which has reduced significantly due to present day better living conditions and sanitation.
Q. In many government hospitals there are no separate cardiac units or wards. In others there are High Dependency Units. Still others like the private sector have state-of-the-art technology, separate cardiac catheterization labs and a host of sophisticated facilities for cardiac care. Do you see this discrepancy in services as a gap in our cardiac care services?
A. The aim must be to provide a cardiac catheterisation laboratory for immediate direct stenting for a heart attack and catheter clot retrieving facility for a brain stroke or a cerebrovascular accident at least to each provincial hospital. We have a long way to go.
Q. Can someone who has had a heart attack lead a normal life, have normal sex relations, continue to work?
A. Yes, it depends on the amount of the damage caused to the heart by the attack. The lesser the damage to the heart, the better will be the life and ability to resume normal activities by the patient.
Q. What is the role of exercise after a heart surgery?
A. Exercise is very important. But must be tailored to each patient. Depending on the patient, assessment graduated exercise will be given.
Q. When should they start these exercises?
A. As soon as possible.
Q. What kind of exercises are usually recommended?
A. Breathing exercises are started as soon as the patient wakes up from anaesthesia and he or she will be ambulated on the first or second day itself.
Q. What about diet? What kind of food ( local ) should he/she take after surgery or while on treatment? High fibre? Meat? Fish? Vegetarian?
A. What is generally called a healthy diet. Less oily, high fibre, low callory diet of natural and fresh source would be ideal.
Q. Do you have any Dos and Don’ts for heart patients?
A. Always lead a peaceful life, always adhere to medical advice, have positive thinking and do not do anything out of this context.