Patient awareness is critical in early detection of ischemic heart disease

Ischemic heart disease is one of the leading causes of death worldwide, including the UAE. Our sedentary life style, smoking, diet pattern and raising incidence of diabetes, hypertension and high cholesterol levels are the main reasons for this.

Treatment of ischemic heart disease really depends upon how the patient presents. Patient can present with acute heart attack with serious risk of sudden cardiac death or as chest pain on exertion. Sometimes, the problem is detected while evaluated for some other reason with no symptoms to the patient.

Patient awareness is critical in early detection of ischemic heart disease. Lack of awareness and self-denial are important reasons for late presentation in patients with heart attack. Most of the time patient thinks gastritis or reflux as the cause of chest pain and delay coming to hospital. The late presentation of patient leads to complications and heart muscle damage. Patient develops heart failure later due to less heart pumping. Any chest discomfort or pain associated with walking or climbing stairs should be evaluated at the earliest. In patients with diabetes, hypertension and family history of heart disease, yearly evaluation by a cardiologist will help in detection of heart disease early and help to avoid nasty surprises.

In patients who have heart attack, the immediate aim is to restore the blood supply to the heart, as there is minimal or no blood flow present in affected heart muscle. Hence these patients require immediate angiogram followed by opening of block in heart blood vessel by balloon angioplasty followed by stenting usually. This procedure is called primary angioplasty and is the treatment of choice for patient with heart attack.

Primary angioplasty is very effective in reducing the risk of sudden cardiac death and also effective in saving the precious heart muscle. It is essential to understand cardiac muscle has no regenerating capacity and hence patient has to live with remaining heart muscle function for the rest of their life after a heart attack. Hence early treatment is required. Persons who are suspected to have chest pain of cardiac nature need to reach the nearest hospital with angioplasty facility at the earliest preferably by ambulance. Using an ambulance for transport helps to prevent early and effective treatment of complications especially sudden cardiac death.

In patients with chronic ischemic heart disease, symptoms and extent of the disease determine the treatment modality. Coronary blocks develop over many years by accumulation of cholesterol in the vessel wall. Once they are formed they rarely regress in severity with medical management. If coronary block is more than 70 per cent they are cleared by angioplasty or bypassed by surgery.

The patient need to understand coronary artery disease is a life style disease, which requires modification of our life style, diet along with medicines and regular exercise. Also quitting smoking is essential. It is not possible to cure the disease with one procedure or one-time medication. This is necessary to be well understood by the patient so as to prevent recurrence of the problem and to effectively manage it.

Coronary angioplasty is very effective procedure in treatment of coronary stenosis. Apart from the minimal chance of restenosis, stenting is durable for life. In this era of newer drug eluting stents (stents are metal scaffolding inserted after angioplasty greatly improve the safety of the procedure) the chance of reblock in the same area is reduced. As the angioplasty techniques improve, we are able to tackle more difficult coronary block including long blocks and total (100 per cent) occlusions easily now. Angioplasty has distinct advantages over bypass surgery. Patient has less hospital stay, no general anaesthesia, minimal pain and early return to work. Patient can resume normal work in three to five days after the procedure. As we tackle more and more complicated coronary blocks with angioplasty, the need for bypass surgery is reduced nowadays.

Bypass surgery is advised in patients with diffuse and multiple coronary blocks and coronary main stem block, especially in diabetic patients. In coronary bypass surgery, patient typically stay eight to ten days in the hospital and take another one month for recovery. It is also important to understand that bypass surgery is not a permanent solution for coronary block, as it is generally perceived. The bypass grafts can get blocked as the time progress, which is usually around 10 years after the surgery, especially if the graft material is a vein from one of your legs. One needs to go for coronary angioplasty or redo bypass surgery if re-block occurs in the bypass graft vessels. Repeat surgery carries more periprocedural risk compared to first surgery.

So regardless of the treatment for block — whether angioplasty or surgery — patients need to modify their lifestyle with healthy food and exercise. Also adequately control their diabetes, hypertension and high cholesterol levels. Periodic check up with the doctor is essential. By adopting this, one can lead a long and recurrent free life after heart attack.