Introduction to Heart Disease
Muhammad Usman Naeem, Abdul Ghani MD
Heart has been described as a mysterious organ by the romantic novelist. Heart disease is also
mysterious. We know just about everything about heart disease but heart attack always comes as
a surprise like a “lightening”. There is never a right time. With the curtailment of smoking,
patients are conscious about fat/cholesterol, they are living better quality of lives. Instead of
dying from heart disease, people are living longer with heart disease, requiring stents, bypasses,
and pacemakers. Statins have reduced heart attacks by 25% but promoted stents and bypass [1].
There is no marker for heart disease. Cholesterol is good but not good enough. The missing
factor is inflammation (read the inflammation chapter). It is difficult to explain it to the patient.
Plaques are not visible by stress tests and sometimes not even in angiograms.
Statin
Statins help reduce the amount of fat in plaque, converting big heart attacks to milder ones. This allows plaque to coalesce and continue to narrow the lumen of the artery causing pain and excretion prompting patients to seek medical help and get stent or bypass.With healthy food and exercise, statin can prevent heart disease. Statin alone converts purely medical disease into surgical intervention. Allowing patients to live and cardiologists rich.
Chest pain
Chest pain is the primary symptom of heart disease and is also the weakest link as the patient themselves have to decide when to seek medical attention. Difficulty breathing requires little experience on the part of the doctor. Recent weakness, which includes shortness of breath (SOB) and chest pain, often doesn’t receive much attention. Chest pain is perceived by the patient so it has individual variation. For instance, a 30-40 year-old male might not initially consider heart disease when experiencing chest pain, assuming it’s a muscle pain. Overall people are scared about the heart so they are unconsciously unaware of pain. Old people will “slow down” and not realize that he/she is having breathing difficulties or some tightness of the chest blaming old age. Some patients get pain in the jaw, shoulders, or upper bark between shoulders. There is a learning curve even for doctors. Additionally, elderly, diabetic, smoker, or female, patients may have mild or no chest pain at all.Blockage vs plaque
We describe heart disease in terms of blockage, not the plaque, and use the word fix or fixed. Cardiologist to the patient:“You have one artery which was 80% blocked. I inserted a stent and fixed it. However, the other artery is 40% blocked. 80% artery has a lot of plaques. The stent only opened 2 cm-long section of the blocked artery, leaving the rest of the artery unaffected”. The word “fixed” is wrong. Now patient is relieved as long as he is on statin.
Serious aerobic exercise and a healthy diet wouldn’t enter his mind only to have another statin put in the next few years.
Cholesterol
Low-density lipoprotein (LDL) “Bad”.High-density lipoprotein (HDL) “Good”.
Triglycerides (TG) “unburned calories”.
LDL is reduced by statin and a low-fat diet. HDL is increased by exercise and fenofibrate (160 mg once a day). Stain reduces the LDL which reduces the fat in plaque. While HDL removes plaque but it needs to greater then 55 mg/dL. Burn to earn. High TG is an indication of obesity/overweight, lack of exercise, and inflammation. Cholesterol is produced in the liver to make steroids, male and female hormones, and bile salts (to help us digest our food). It is essential. When we reduce fat in our diet, the liver compensates by producing more cholesterol to make up for the decreased fat intake. As a result, only 10-15% of cholesterol is reduced in the blood. When the patient takes statin cholesterol is reduced. To compensate for this there is more fat captured from food from gut-to-gut maximum benefit. We should reduce fat in the diet and take statin.
Physical inactive person
He is often fat. He walks from car to office, car to store, and store to car. He develops heart disease faster because there are no symptoms of pain or difficulty breathing (he is inactive). By the time, heart disease is diagnosed, the disease is advanced to heart failure.What happens in heart attack
When fatty plaque ruptures, there is a gluelike tissue factor (consistency like tooth paste) is released from the plaque. Platelets cells circulate in the blood and accumulate, forming a plaque that seals the bleeding spot. Platelets with clotting factors and tissue factors make a big gob that seals on site of ruptured plaque and stops the blood supply so the heart muscle downstream starts to die which is a heart attack.When you take statins, fatty plaque loses fat and dries up. With ASA, platelets are less sticky. With vegetables and a low-fat diet, clotting factors are less active. Meat increases platelets stickiness. A heart attack could occur but the gob will be smaller and only a small part of the heart muscle dies.
With Statin dried up plaque still piles up and starts enclosing the lumen leading to stents and CABG. Fewer heart attacks but lots of stents.
Future of heart disease
With the help of Google, people are understanding chronic heart disease better. They are more active in counting their steps. They are learning about cardiac screening tests and asking doctors good questions. Prevention of disease would still be difficult due to lack of exercise and poor diet. Fast food is cheap, tasty, and available. There will be more people with more chronic diseases but they will live longer. Thanks to American Medicine.One liner
- People that do cocaine can have heart attacks at a young age. Cocaine is associated with sudden increase in blood pressure and heart rate.
- Patient who gets angry often can rupture the plaque. Their BP and heart rate suddenly go up. They need to be on beta blockers e.g. carvedilol.
- Obese, smoker, and diabetic patients are at high risk of heart attack. Their platelets are very sticky. They could die at the scene before the ambulance arrive due to the speed of the heart attack.
Hierarchy of heart disease
Heart disease is losing its importance even due to statin and stunts. There is a plethora of diseases like hypertension (HTN), diabetes (DM), and chronic pain. Each disease is being treated separate entity. American Heart Association (AHA), American Diabetes Association (ADA), and doctors are not talking about common roots. Walking and a healthy diet prevent and stabilize heart disease. It is difficult to convince patients because there are no symptoms early as “no harm no foul”. It takes years to develop heart disease. It requires slow thinking. A person with no exercise and unhealthy food early in could be developing HTN, DM, heart disease, and cancer.
A person with exercise of healthy food could be preventing HTN, DM, heart disease, and cancer.
End game
When you are getting heart disease with unhealthy and lack of exercise you are getting into some other problems like cancer, stroke, or memory loss.What is the solution?
Free 4 years of college, choice of better food, and a better executive function.Role of walking and healthy food in heart disease
Patient needs to walk 3 miles every day and eat a plant-based diet to prevent heart disease, a second heart attack, the need for a second stent after the first one, and heart muscle failure.Citation list
- ENDO, A. (2010). A historical perspective on the discovery of Statins. Proceedings of the Japan Academy, Series B, 86(5), 484–493. https://doi.org/10.2183/pjab.86.484
Download Here…
Other Articles
Next
October 22, 2024
Cholesterol and Statin
Previous
September 18, 2024
Sugar; The Periculum to Human Health
[…] Introduction to Heart Disease […]