Even though so much is written about heart disease, false perceptions still exist. Dr Aaron Wong, a senior consultant in the Department of Cardiology at the NHC, examines the four most common myths and debunks them.
Even though so much is written about heart disease, false perceptions still exist. Dr Aaron Wong, 42, a senior consultant in the Department of Cardiology at the National Heart Centre, examines the four most common myths and debunks them.
“Bypass surgery is more dangerous than ballooning and stenting.”
Many people think that ballooning or stenting, a non-invasive procedure for treating blocked arteries, is safer than bypass, which involves open heart surgery.
However, according to Dr Wong, this is not necessarily true. Which is safer depends on several factors: age, whether heart function is poor or normal, patient history and the type and number of blockages in arteries.
Ballooning involves implanting a small, expandable wire mesh in clogged arteries as a scaffold to keep them open. It is generally recommended for patients below 60, to postpone the bypass.
In heart bypass surgery, blood vessels taken from another part of the body are grafted around the clogged artery, bypassing it so that blood flow is not obstructed.
Bypass is recommended for older patients, as it can last at least 10 years.
If a small number of arteries are blocked (one or two), then ballooning is recommended. But if more arteries are blocked, a bypass is a better solution.
Ballooning is fine for patients whose hearts are working normally, but can be a risky procedure for those whose hearts are weak. This is because a bypass is done under “stable” conditions – the heart is stopped while being operated on – and a heart-lung bypass can be relied on if the heart fails during the surgery. In a heart-lung bypass, blood from the heart is drained into an artificial lung, which provides oxygen to the blood. The blood is then pumped back into the patient.
In contrast, arteries may rupture during the ballooning procedure and this “can lead to death on the table”, said Dr Wong.
“I have blocked arteries, so I need immediate treatment.”
This is not always true. Whether or not immediate treatment is needed depends on type, and importance, of the blocked artery.
Immediate treatment is necessary if main arteries are blocked, but not when small arteries are. If a patient has blockages but they have not made him unwell, then he does not have to be treated right away as the blockages have “accumulated gradually” and are not life-threatening, according to Dr Wong.
Treatment is carried out only if it relieves chest pain (angina) or if it will prolong the patient’s life.
In fact, if there are blockages in very small arteries, the heart will do its own “natural bypasses”. Over the years, new blood vessels, called collaterals, grow and form a bypass around the blockage. Hence, no treatment is needed.
“I have poor heart function, but I am well. So I don’t need treatment.”
Many people diagnosed with heart problems can still go about their normal lives without significant changes to lifestyle. They think they are “fine” and do not need to take their medication regularly, or can skip some types of it.
Such attitudes can be dangerous, warned Dr Wong. People whose hearts are no longer working at 100 per cent may have no symptoms because the body compensates for the low function. They can carry on as normal, not knowing they have a ticking bomb inside them.
In fact, prognosis for heart failure is worse than for cancer. According to Dr Wong, 80 per cent of people with heart failure die in five years. Medicine helps to prolong their lives. Some essential medicines for patients with poor heart function include beta-blockers and angiotensin converting enzyme (ACE) inhibitors.
“Healthy people die during exercise, so exercise is dangerous.”
Alarmed by reports of people dying during strenuous exercise, some heart patients have stopped working out. But they should not worry.
“Sudden death is mostly due to underlying problems,” said Dr Wong. Some heart disease cannot be detected by the echocardiogram or electrocardiograph, instruments used to detect heart disease.
In other words, people need not be afraid of exercising.
But if you have a heart problem and any symptom like chest pain, breathlessness, palpitations or fainting that occurs during exercise, do not ignore them.
Source: Mind Your Body, The Straits
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