Prevention is always better than cure

75 per cent of heart diseases can be prevented 75 per cent of heart diseases can be prevented

In our societies, especially the Middle East and India, heart diseases have increased a lot. In light of this, what should people be aware of? Dr Anil Kumar R, Lead Senior Consultant Cardiologist, Aster Medcity, Kochi, Kerala, stresses that people should know their numbers - the cholesterol value, sugar and blood pressure.
"If any of these are abnormal, at any age, let's say if a 25-year-old has high BP, high cholesterol, or high sugar, then he/she is more prone to heart diseases and heart attacks. This doesn't come out of the blue. Ninety per cent of the heart attacks will have at least one of the risk factors contributing to the development of the disease. Only in less than 10 per cent will we be not able to identify the causal factor. Chronic stress can aggravate or bring in sugar, blood pressure and make the quality of cholesterol worse," says the cardiologist in an interview with Khaleej Times.
He stresses that at least 75 per cent of heart diseases can be prevented. "The World Heart Day this year focused on "'My Heart, Your heart, Everyone's heart'. For taking care of the heart, everyone needs to know their numbers: how much is your blood pressure, sugar and cholesterol. If these are abnormal, change your lifestyle by controlling diet and exercise or if you need medicine, take it as advised by a physician or cardiologist."
But despite all these precautions, certain discomforts may come in at times, which one has to be aware of. "Any discomfort below the jaw, above the umbilicus, that is somewhere in the upper abdomen to your jaw, please don't brush it off as gas. This is the commonest misconception that happens in society. Passing off any chest discomfort as gas often leads to disastrous consequences. If you walk 100 or 200 metres and you feel a catch in the chest, that can never be due to gas. Please don't conclude this symptom as gastritis and think that it will pass off," warns the doctor.
However, pricking chest pains pain which last few seconds need not be from the heart. Similarly, chest pain which comes on a deep breath or coughing or sneezing or turning to one side are generally not from the heart. Usually, heart attack pains are felt as a weight on the chest, which sometimes can go on to the left hand, says Dr Kumar.
He cautions, "Remember, it can go up to the jaw too. Some people feel dental discomfort. But you should realise that anything that starts from the chest and goes up till the jaw is due to a block in the heart. A person especially with a risk factor, anybody with high BP, high cholesterol, high sugar or people who are in the risk factor by age, a man over 50 or a lady over 60, if you are having these symptoms, you should evaluate yourself through an ECG and a blood test."
Here it is important to note that in the early stage of chest discomfort, if you take an ECG and the results are normal, it doesn't rule out a heart attack. "It doesn't rule out heart-related chest pains. A normal ECG cannot tell you that everything is normal and it is okay to go home. You have to do a blood test called troponin," notes the doctor.
"Troponin is heart muscle protein. It has no business to be in the blood. If this protein is in the blood, it means it is dissolving, and injury is happening to the heart as it is leaking into the blood. So if the troponin test is positive, even if the ECG is normal, it means that the patient is having a heart problem. It is a minor attack," says Dr Kumar.
The doctor confirms that in the case of a major attack, there will be full-blown ECG changes. "This is something that we need to highlight. And even in the case of troponin, in the first half an hour of chest pain, it may be normal. So, if a patient is having on-going chest pain with a normal ECG and normal troponin, it is better to keep the patient in the hospital for observation and repeat the tests after four to six hours. You will then see changes in the ECG and the blood."
"Even if the first blood test is negative, again observe the patient for four hours, repeat the test, the troponin might become positive. This is somehow often missed in general clinics at times. There are many instances when the ECG was normal, and the patient was sent home and collapsed on the way. ECG alone is not enough to rule out a heart attack," Dr Kumar warns. If ECG is normal and there is no ongoing chest pain and troponin is negative, it is useful to do a Treadmill test to pick up silent blocks. It is important to note that the Tread Mill Test (TMT) picks up blocks that are only above 70 per cent. If treadmill is positive it is worth doing an angiography to specifically identify the site and the number of blocks. It is also to be noted that even with a normal treadmill test, a person with risk factors can have a heart attack. Especially in smokers and diabetics, even a 50 to 60 per cent cholesterol blockage, can develop surface injury and a clot  can form and cause a heart attack. This is the fallacy of TMT. Still it is the simplest method of evaluation, it is not invasive, there is no radiation, you can make anyone walk and do the test," affirms Dr Kumar.
So in short, it is important to prevent heart attacks by controlling your risk factors. It is equally important to pick up the signs of a heart attack or block at the earliest and get proper treatment. This is the best way to take care of "My Heart, Your Heart and Everyone's Heart" - the motto of World Heart Federation for the year 2018.
 - suchitra@khaleejtimes.com

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