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“Heart attack kills more rapidly than any other disease,” says Dr Muhammad Hamid Saeed

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A cardiologist at Faisalabad Institute of Cardiology, in an interview with Haleema Azmat


Doctors in this segment shed light on their specialties to give you awareness about your common problems and misconceptions. A Urologist will be here next month to enlighten the readers about his forte. Write to us if you want your queries answered.


SN: Which heart diseases are common in Pakistan?
Unfortunately, every type of heart disease is common here. By-birth defects, rheumatic heart disease (which occurs due to repeated bad throat in children), ischemic heart disease also called angina (in which the blood vessels constrict), and heart muscle problems (that can occur with post-viral infections) are all common in Pakistan.

SN: Why do by-birth heart defects occur?

By-birth or congenital heart disease is common in our country because of poverty. Mothers usually do not take proper diet during pregnancy and in case of fever take medicines from quacks or even doctors for that matter, which affect the baby and cause birth defects. Unlike developed countries, screening here is not done at a standard level therefore can miss out birth defects. Unless severe, these defects generally get detected late. Women should take care of their diet when pregnant and avoid unnecessary medicines; even desi. And fetal screening (ultrasound) is important for timely identification, especially if there is a doubt or family history.

SN: How is a bad throat linked to heart disease?

Well, when the throat is infected by bacteria it starts a reaction in the body which makes the joints swell and affects the heart valves. Repeated problem in children can cause rheumatic heart disease. This is common in Pakistan due to poverty, overcrowding and unhygienic sanitary conditions. However, the disease is unknown in the western countries. Unfortunately, it gets detected in young or middle aged children. By then the heart valves have constricted considerably and it can only be treated through cardiac surgery. Which of course is expensive. Moreover, because the problem has vanished from the developed countries, almost no one is working on developing its vaccination or preventive side. In this scenario, we should be careful about our health. Parents should avoid giving sour foods to their kids and instead give them awareness about the problems it can cause. Give them a healthy diet so they develop strong immunity. School canteens should also be discouraged from offering sour foods. Avoid cold drinks too as they contain phosphoric acid which rapidly affects the throat. And in case of bad throat, timely use of antibiotics can also save individuals from further problems.

SN: How does heart muscle disease occur?
Heart muscle disease is caused by virus infection. Here I would like to highlight that people should avoid using hakeemi medicines unnecessarily as they contain heavy metals which can damage the heart muscles causing the heart to dilate and become weak. The heart cannot recover after this.  Unless from standard companies, avoid these medicines.

SN: Why are heart problems increasing in Pakistan?
Unfortunately, we have accepted all the curses of the modern world but are not adopting the benefits it offers. High fat diet and refined foods have become an integral part of our diet. Moreover, availability of conveyance at all times has deprived people from walking. And there is no trend of cycling. Even villages now do not have a healthy lifestyle like they used to. With introduction of machines, physical activity of villagers has now reduced. But their eating habits are still the same. High fat diet that includes ghee and butter along with hookah culture is causing health problems. Similarly, in urban areas the young lot is into cigarette smoking. All these things are causing premature coronary artery disease. Patients as young as 20-25 years are having heart attacks. This means people are falling ill in their productive age. The number of patients in hospitals is increasing and new treatment is always costly. A person who has heart disease at the age of 70 has spent major part of his life. But a person who has it at 40 is still in his productive years. Government should take notice of this and ban smoking. Only 16 percent white population smokes in America, while 30 percent are black population coming from other nations. Smoking there is discouraged to such an extent that the rating of movies goes down if the act is portrayed in the movie. But there is no check here. Moreover, people should stop taking extra calories. The best way to avoid this is by only taking the required number of calories each day. Carefully select your food and avoid eating to a full stomach. Pait bhar k kahny mai koi aqalmandi nahi (It is not wise to eat to full stomach). When it comes to physical activity, we can spend the whole day watching a cricket match but we cannot spare half an hour for daily exercise.

SN: How can the government play its role in curbing these issues?
The government does not realize that the amount of revenue they are gaining from the tobacco industry is nothing as compared to what they are spending on importing cardiac surgical equipment and devices. Instead of increasing the price of cigarettes, they should take other steps to discourage smoking culture. It is sheer hypocrisy to place a pictorial image of a cancer patient on the cigarette pack on one hand and on the other hand make it freely available in the market. If people are smoking even after looking at the image then they have become immune. The government needs to use other strategies. For instance, government hospitals refuse to treat heart patients who smoke. Because all the government’s budget is being wasted on this preventable disease. Also, a campaign should start for promoting half hour exercise routine. Firstly, government and semi- government organizations should be strict in applying this. They should keep a check whether their employees are healthy and  engage in exercise. They should also encourage them to quit smoking. One ad in a day should be dedicated to health awareness on radio and TV. Moreover, through mobile networks, the government should send health related tips daily to every user. Along with prevention the government should look into new treatment options too. Like stem cell treatment is becoming common in the world.  Stem cells can allow regeneration of new heart cells. Relevant organizations in the country should start working on them so that when the treatment is available it is not expensive and out of the reach of common people. Before private investors take this up as business, the government should take this project under its control and make sure the prices do not rise unnecessarily.

SN: Are heart diseases more common in men?
Generally, heart problems occur more in men but some disease are not gender specific like rheumatic and congenital heart disease. Ischemic heart disease, without any risk factor can start after 45 years in men and after 55 in women. Women have natural protection but if someone is diabetic or has high blood pressure then the risk factor becomes high.

SN: How serious can a heart problem get?
It can become very serious. People tend to underestimate it. With a full blown heart attack there is 23 percent chance of sudden death. No other disease can cause immediate death than heart attack. According to American figures, people who come to hospitals are the lucky 75 percent who have survived a heart attack. In rheumatic heart disease, even after surgery and placing new valves, the patient has to take lifelong medicines. It is a crippled life. When congenital heart disease is not detected timely it can cause heart failure.

SN: In which age group are heart diseases common?
Effects of congenital heart disease start to appear at around 10-11 years of age. Rheumatic heart disease can start after five years of age but gets detected when the patient is around 15 to 30 years old. Ischemic heart disease starts from 25 years in Pakistan especially those who smoke or are hypertensive.

SN: What affects cholesterol levels?
Diet definitely has an affect but only to an extent. Unfortunately, southeast Asian population is pre-disposed to having high cholesterol levels. So, after the age of 40 one should definitely get their cholesterol checked. If it is high and cannot be controlled with diet modification and exercise then regular medicine intake is necessary. Usually diabetes, blood pressure and cholesterol do not have symptoms. Blood pressure is considered a silent killer. The symptoms become apparent at a later stage.

SN: Are all heart diseases preventable?
To a great extent yes. Rheumatic disease is preventable if you start controlling sore throats in kids, maintain hygiene and have good diet. Incidence of congenital heart disease can be reduced if female health during pregnancy is taken care of. Angina or ischemic heart disease is not completely preventable but its onset can be delayed.

SN: What is the difference between angina and heart attack?
Angina is a common lesser degree pain that people feel while walking or sitting. It occurs due to compromised supply of blood to the heart and lasts for about five to 10 minutes. If this pain goes on for half an hour and is severe then clinically it is a heart attack. It can have other symptoms too like vomiting, nausea etcetera. It occurs when the blood vessel completely stops supplying blood to the heart.

SN: Does angina start in the chest?
Angina pain starts in the chest. But it can happen anywhere between the naval and the jaw; arms, back of neck, in between chest, above stomach, back, anywhere. Any unusual pain that increases with walking or starts after a meal or an individual experiences sweating or shortness of breath as well then consult a physician immediately.

SN: What are the symptoms of high and low blood pressure?
High blood pressure usually does not have any symptoms. Only 20 percent people have headaches with very high blood pressure. Constant high readings of blood pressure, even during sleep (that does not come down without medicine) is hypertension. Women usually have blood pressure on the lower side. If someone has 90/60 mmHg with no symptoms, has warm hands and is doing routine chores easily then there is nothing to worry about.

SN: What causes the heart to increase in size?
Heart muscle is elastic and continuous pressure is being generated in our heart while pumping. When it gets damaged, its elasticity goes away and the pressure that keeps generating with every beat causes it to swell. Its size increases and working capacity decreases. Shortness of breath is the common symptom that occurs after this. The normal functioning of heart gets disturbed and the blood starts accumulating in the lungs. Such patients should reduce water and salt intake, take medicines carefully and have regular checkups. A patient cannot recover with this much damage. Like I mentioned, stem cell is the future treatment. Heart transplant or stem cell treatment are the only hope for heart failure patients.

SN: Does stress have a role in heart diseases?
Definitely it has a role. People who are under stress all the time and have hostile personalities, also known as type A personalities will have high blood pressure as adrenaline hormones get increased in their bodies. And the problem can precipitate in already heart patients.
SN: What are the signs of stroke?
If blood supply is compromised in the heart then heart attack occurs. If this occurs in brain then stroke occurs. Suddenly one side of the body stops functioning. Other than this there is numbness, behavior change, and grasping and recognition become a problem.

SN: Is irregular heart beat a serious problem?
As the heart damages, its electronics get disturbed and irregular heart beat occurs. It can occur due to a congenital defect. But mostly it is the result of aging or ischemic heart disease in which heart rate can increase or decrease. Paralysis can occur due to this problem. Pacemakers help regularize the heart beat. However, it has serious other problems too in which shocks need to be given to the patient.

SN: Secret to keeping a heart healthy?
Half hour daily exercise, modifying diet patterns and quitting smoking are the secrets to a healthy heart. Regular physical activity decreases the incidence of diabetes and ischemic heart disease. Take simple diet that includes fruits and vegetables.

SN: Well, that was an enlightening interview, is there anything left that you would like to add at the end?
In regards to preventive cardiology, education should start after a child has done five years of schooling. These diseases are increasing rapidly. A health related subject should be introduced at school level. Kids should know about health. Instead of watching a 12 hour match, they should at least exercise 12 hours in a month. People think watching a match is a healthy activity. However, you can just become sick after watching a whole day match. That is how you become couch potatoes. Give priority to your health. A healthy nation will make healthy decisions; a sick nation will make sick decisions.

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