BASIC KNOWLEDGE ABOUT HEART DISEASE FOR HEART PATIENTS

Heart Disease

Heart Disease, commonly called Coronary Heart Disease or Ischemic Heart Disease is basically deposition of fatty material inside the tubes supplying the heart. These tubes called Coronary Arteries (named LAD, RCA and LCx) are mostly three in number and supply blood (with Oxygen) to the heart muscles.
The fatty matter (mostly made of Cholesterol and Triglycerides) when accumulates more and more over the years-block the coronary arteries by more than 70-80% leading to shortage of blood (supplying oxygen) – specially on exertion or physical activity. This leads to symptoms of chest pain, breathlessness, chocking etc. called Angina. Though heart disease starts early the difficulties are only felt after decades as heart tubes have 70% extra capacity – 30% being the maximum requirement of the heart. The Angina symptoms become worse as the blocks reach 80-90%.
The Coronary Arteries are two on the left side (LAD – Left Anterior Descending Artery and LCx -Left Circumflex) and one on the right side (RCA- Right Coronary Artery). LAD is the biggest of them supplying 50% area of the heart followed by RCA (30% area) and LCx (20% area). Coronary Heart Disease is the most common and fatal disease of the world today – causing about 30% of deaths across the world. This disease is not only preventable but also reversible.

Heart Attack

This is the most important complication of heart blockages. This leads to acute chest pain or breathlessness at rest – and is caused by 100% blockage of any of the coronary arteries. This happens suddenly and has the ability to instantly kill a person.
Simply speaking, heart attacks happen as the growing blockage stretches the membrane covering them (medically called Intima) and ultimately rupturing it. It is similar to adding currency notes inside a bundle of notes ultimately breaking the rubber band holding them together.
Exactly this is what happens in heart attack. Following the breaking of membrane – clotting chemicals are released in the flowing blood and making a clot. The clot converts the already blocked tube to 100% – instantly stopping the blood supply of the muscles getting blood from that particular tube. The affected area gets damaged or dies without blood supply leading to chest pain at rest. Heart attacks may be minor, major or massive depending on the location of the blockage. Heart attacks are preventable with more than 98% surety.

Causes of Heart Attack

Causes of heart attack are multiple – but the deposits are mainly fats. Two kinds of fats are mainly responsible and actually deposit. These are Cholesterol and Triglycerides. They come from our food and also manufactured in our body (mostly in Liver). These two – along with a fatty chemical called HDL lead to LDL which ultimately deposit in the walls of the heart tubes. HDL is supposed to be good Cholesterol and can be increased by walking, Yoga, reducing stress and eating green vegetables. HDL cannot be supplied to the body from outside.
Six more factors have the potential of speeding up the fat deposition process and these are high Blood Pressure, Diabetes, Smoking and Tobacco, Obesity, Stress and to some extent Alcohol. If they are also present or not controlled the blockage formation happens faster. These days Pollution and Toxicity is also considered to be factors which speed up the block formation.
Four factors can stop or slow down the process of blockage formation and these are Walking, Yoga, Fiber and Antioxidants. Fibers are obtained by mainly eating Fruits and Vegetables. Antioxidants are chemicals which prevent blockages by stopping the oxidation of the fats which make them deposit faster. Antioxidants are mostly present in Fruits and Vegetables and can be supplemented from outside.
Heredity is also one factor and one should remember that it leads to blockages through high Cholesterol and Triglycerides. It is seen that those who have history of heart problem in the family are usually have very high capacity to produce extra Cholesterol and Triglycerides. Some have also Diabetes and High BP in the family. But if we can control these factors (Cholesterol, Triglycerides, Blood Pressure and Sugar) by medicines – the effects of heredity can be minimized to 1% from 100%.

Prevention of Heart Attack

If we use common sense, to prevent heart attack we must protect the membrane covering the blockage. If it does not burst – the clot will not form and heart attack will not happen. So, the blockage should not grow and further stretching of the membrane will not happen. Best is to remove some of the fats from inside the membrane to de-stretch the membrane.

First thing we should do for this is to stop the supply of Fats called Cholesterol and Triglycerides in the food. Then we should increase HDL to more than 25% of Cholesterol. Thus LDL will not form and deposit. Oxidization of LDL can be prevented by Detoxification and Anti-oxidants. Plus we should control high BP, sugar, stop smoking/ tobacco, reduce obesity and control psychological stress.

We should also do Walking and perform Yoga. They have the potential of reversing heart disease. These are the best ways to prevent Heart Attack.
Cholesterol is present in only one food in the world – that is Animal Food. These foods – Meats of all kinds, Fish, Eggs, Milk and Milk products should be avoided to cut down Cholesterol in the blood. Milk has a beauty – fats can be removed from it to a great extent. Thus fat free milk can be allowed in small quantity. The Cholesterol of Eggs in mostly concentrated in the Yolk – the yellow part. So, white of eggs can be allowed.
Triglycerides are 99.9% part of almost all oils. Fortunately it has no taste. If we can modify our cooking methods 90% of the Triglycerides flowing in the blood can be taken care. For this Zero Oil Cooking is the best policy.
Another major source of Triglycerides is Nuts (Dry Fruits) and Seeds – as oil can be extracted by crushing them. They also need to be avoided.
Our body’s minimum requirement of oil will still come from small quantities of invisible oils (oils that we cannot see from outside) present in every food. Recent study (ISCHEMIA trial, 2009) has shown that Medicines and Lifestyle can be a replacement of Bypass Surgery or Angioplasty.

Test for Heart Patients

Whenever someone is suspected to have a heart disease – the following tests can be conducted to confirm heart disease, look at the risk factors and measure the stage of the disease or damage, if already happened.

1.) ECG: This is the most preliminary test and informs whether there is any shortage of blood to the heart muscles at rest. In most heart patients with 70-90% blockage ECG is normal as there is no rest pain. ECG can also show heart attack and indicate past heart attack.

2.) TMT: In this test heart rate is increased gradually while the ECG is being taken. The patient walks on the TMT machine whose speed and inclination is increased gradually. If it is positive – the blocks are more than 70%. If it is negative – the blocks still can be anything below 70%.

3.) Echocardiogram: In this test Heart is studied by Ultrasound while the patient lies down on the examination table. It gives a very important parameter called LVEF or EF (Ejection Fraction) of the heart. This tells about the functioning of the heart – and whether there is any damage to the heart by a past heart attack. Normal LVEF is 60%.

4.) Lipid Profile: This is a simple blood test which tells about the blood concentration of Cholesterol, Triglycerides, HDL and other Lipid components. Saaol wants Cholesterol at or below 130mg/dl; Triglycerides at or below 100mg/dl and HDL above 25% of Cholesterol. These are pre requisite for preventing heart attacks.

5.) Blood Sugar and HbA1c: This blood test is for Diabetes – which is a close associate of heart disease. We want Blood Glucose fasting below 100mg/dl; post prandial below 140mg/dl and HbA1c (which shows sugar control for last three months) below 6.5%. These figures, if maintained, makes heart safe.

6.) CT Coronary Angiography: This is the latest test which has displaced Conventional Catheter Angiography as a gold standard to diagnose heart blockages. In this two minute test patient lies on the table, the table moves inside a circle so that heart comes under the circle where cameras are rotating. Then a dye is injected and few seconds of X-rays are taken. Now the radiologists can see the plates and diagnose the blockages. The beauty of this test is that no wire is inserted inside the body – so no chances of complication. Reports are as accurate as conventional Angiography. The cost is about Rs. 7000. Though the cardiologists do not like this test for economic reasons – this test has become very popular as it is simple, no admissions are required, no complications, low radiation and low cost. Saaol recommends this test in place of Catheter Angiographies.

7.) Stress Thallium Test: This test is an advanced version of TMT or stress test. With a radioactive dye – which is picked up by heart muscles stress test is done in this procedure. The heart is then scanned to know how much of the heart is viable and which area is damaged. This is often done to assess heart patients after a heart attack.